Provider Demographics
NPI:1972883353
Name:MICHENER, MEETA SHAH (MD)
Entity type:Individual
Prefix:DR
First Name:MEETA
Middle Name:SHAH
Last Name:MICHENER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 ZANG ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1052
Mailing Address - Country:US
Mailing Address - Phone:303-989-4357
Mailing Address - Fax:601-988-2017
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5514
Practice Address - Fax:601-984-2893
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS821-L2084P0800X
CODR.00575782084P0804X
PAMD4587112084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry