Provider Demographics
NPI:1427106277
Name:SHAHI, KALA (NP)
Entity type:Individual
Prefix:MRS
First Name:KALA
Middle Name:
Last Name:SHAHI
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:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:MD
Mailing Address - Zip Code:20861-0157
Mailing Address - Country:US
Mailing Address - Phone:301-570-9700
Mailing Address - Fax:301-260-2838
Practice Address - Street 1:9800 FALLS RD
Practice Address - Street 2:STE 3
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-3944
Practice Address - Country:US
Practice Address - Phone:301-765-9255
Practice Address - Fax:301-299-3838
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114087363LF0000X
DCRN57972363LF0000X
DELG0000392363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD144230YRVMedicare PIN
MD120804ZAWGMedicare PIN