Provider Demographics
NPI:1699439992
Name:SHAH, NATASHA (MSPAS)
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MSPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 AGUA DULCE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619-8573
Mailing Address - Country:US
Mailing Address - Phone:818-939-4728
Mailing Address - Fax:
Practice Address - Street 1:704 AGUA DULCE AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93619-8573
Practice Address - Country:US
Practice Address - Phone:818-939-4728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-24
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CAPA60725363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant