Provider Demographics
NPI:1063879369
Name:SHAH, PAYAL (NP)
Entity type:Individual
Prefix:
First Name:PAYAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31500 W 13 MILE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2172
Mailing Address - Country:US
Mailing Address - Phone:248-509-4070
Mailing Address - Fax:248-509-4080
Practice Address - Street 1:31500 W 13 MILE RD STE 100
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2172
Practice Address - Country:US
Practice Address - Phone:248-509-4070
Practice Address - Fax:248-509-4080
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704278319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily