Abdullah Shah, DDS, BSPH

Primary specialty

DentistTaxonomy code 122300000X

License

DB-2023-0102 Issued in NM

Practice address

2625 McNutt Rd
Sunland Park, NM 88063-9608

Phone

(505) 750-7865

NPI assigned

Apr 14, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

Networks

• devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a
• CO HMO

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1681430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688947200000",
    "number": "1053007864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 MCNUTT RD",
            "city": "SUNLAND PARK",
            "state": "NM",
            "postal_code": "880639608"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2625 MCNUTT RD",
            "city": "SUNLAND PARK",
            "state": "NM",
            "postal_code": "880639608",
            "telephone_number": "505-750-7865"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "ABDULLAH",
        "name_prefix": "Dr.",
        "credential": "DDS, BSPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-14",
        "last_updated": "2023-07-10",
        "certification_date": "2023-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NM",
            "license": "DB-2023-0102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Srikanthi Saladi, DMD
• Victor Sanchez, REGISTERED NURSE
• Jasmine Marie Sandoval
• Nancy Segura
• Kerima B Setra, RDH
• Kimberly Ann Sheley
• Shes Known
• Brian Sieve, CASE MANG
• Juan Jose Smith, CASE MANGER
• Socorro Soriano

• Dentist in Sunland Park, NM
• Providers in Sunland Park, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.