Most Relevant Information
Provider Data
| NPI Number: | 1003080664 |
| Provider Name: | MIRA E SHAH M.S. CCC-SLP |
| Entity Type: | Individual |
| Taxonomy Code: | 235Z00000X |
| Specialty: | Speech-Language Pathologist |
| License Number: | 11905 |
Most Important Dates
| Enumeration Date: | 04/15/2008 |
| Last Updated: | 04/15/2008 |
Provider Practice Location
2855 SE 61ST AVENUE
PORTLAND
OR
972061320
Practice Location Phone/Fax
| Phone: | 5033480931 |
| Fax: |
Provider Mailing Location
2855 SE 61ST AVENUE
PORTLAND
OR
972061320
Provider Mailing Phone/Fax
| Phone: | 5033480931 |
| Fax: |