| Shah & Associates Llc | |
|
26840 Point Lookout Road Leonardtown MD 20650 | |
| (301) 475-5577 | |
| (301) 373-6900 |
| Full Name | Shah & Associates Llc |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 26840 Point Lookout Road, Leonardtown, Maryland |
| Authorized Official Name and Position | Dipak Shah (PRESIDENT) |
| Authorized Official Contact | 3014755577 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shah & Associates Llc Po Box 603 Leonardtown MD 20650-0603 Ph: (301) 475-5577 | Shah & Associates Llc 26840 Point Lookout Road Leonardtown MD 20650 Ph: (301) 475-5577 |
| NPI Number | 1669686432 |
|---|---|
| Provider Enumeration Date | 05/10/2007 |
| Last Update Date | 08/10/2023 |
| Certification Date | 08/08/2023 |
| Medicare PECOS PAC ID | 6103901574 |
|---|---|
| Medicare Enrollment ID | O20080310000267 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669686432 | NPI | - | NPPES |
| 149802900 | Medicaid | MD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Dipak K Shah |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1598792731 PECOS PAC ID: 8628080942 Enrollment ID: I20060630000260 |
| Provider Name | Justine S Ellerman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1043505324 PECOS PAC ID: 7810113255 Enrollment ID: I20140722000012 |
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