Provider Demographics
NPI:1093546426
Name:SHAH, HIMJA V (CRNP-OB/GYN)
Entity type:Individual
Prefix:MRS
First Name:HIMJA
Middle Name:V
Last Name:SHAH
Suffix:
Gender:F
Credentials:CRNP-OB/GYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 RAVENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-7592
Mailing Address - Country:US
Mailing Address - Phone:433-845-3930
Mailing Address - Fax:
Practice Address - Street 1:2000 MEDICAL PKWY STE 310
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-3754
Practice Address - Country:US
Practice Address - Phone:410-266-7755
Practice Address - Fax:410-266-1141
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR226816207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology