Active NPI
Fatima Imran Shah, RD,LD
- Registered Dietitian
- Fenton, MO
National Provider Identifier
1104192004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 2011027109
- Practice address
- 1015 Bowles Ave
Fenton, MO 63026-2394 - Phone
- (636) 496-2543
- NPI assigned
- Mar 26, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 2011027109 | MO | Primary |
Addresses
Primary practice location
1015 Bowles Ave
Fenton, MO 63026-2394
Mailing address
1331 Culpepper Ridge Dr
Ballwin, MO 63021-7526
Phone (636) 225-1332
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2011027109 | MO | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1332720000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1332720000000",
"number": "1104192004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1331 CULPEPPER RIDGE DR",
"city": "BALLWIN",
"state": "MO",
"postal_code": "630217526",
"telephone_number": "636-225-1332"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1015 BOWLES AVE",
"city": "FENTON",
"state": "MO",
"postal_code": "630262394",
"telephone_number": "636-496-2543"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "FATIMA",
"middle_name": "IMRAN",
"credential": "RD,LD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-03-26",
"last_updated": "2012-03-26",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "MO",
"license": "2011027109",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fenton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.