Provider Demographics
NPI:1427507573
Name:SHAH, HEENA PATEL (CRNP)
Entity type:Individual
Prefix:
First Name:HEENA
Middle Name:PATEL
Last Name:SHAH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:HEENA
Other - Middle Name:M
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1871 SANTA BARBARA DR STE 1
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-4144
Mailing Address - Country:US
Mailing Address - Phone:717-560-1970
Mailing Address - Fax:717-560-2278
Practice Address - Street 1:1871 SANTA BARBARA DR STE 1
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-4144
Practice Address - Country:US
Practice Address - Phone:717-560-1970
Practice Address - Fax:717-560-2278
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5008984363LF0000X
PASP020171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1036356500002Medicaid
NC5008984OtherNORTH CAROLINA BOARD OF NURSING LICENSE