Active NPI
Manzoor Ali Shah
- Clinical Neurophysiology Physician
- West Columbia, SC
National Provider Identifier
1407439144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neurophysiology Physician
- License
- 0000
- Practice address
- 1304 Sunset Blvd # 203
West Columbia, SC 29169-5914 - Phone
- (888) 851-3677
- NPI assigned
- Apr 30, 2021
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Neurophysiology Physician | 2084N0600X | 0000 | AZ | Primary |
Addresses
Primary practice location
1304 Sunset Blvd # 203
West Columbia, SC 29169-5914
Mailing address
1304 Sunset Blvd # 203
West Columbia, SC 29169-5914
Phone (888) 851-3677
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 |
|---|---|---|---|
| 0000 | AZ | MD | Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619740800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622332800000",
"number": "1407439144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1304 SUNSET BLVD # 203",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291695914",
"telephone_number": "888-851-3677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1304 SUNSET BLVD # 203",
"city": "WEST COLUMBIA",
"state": "SC",
"postal_code": "291695914",
"telephone_number": "888-851-3677"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "MANZOOR",
"middle_name": "ALI",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-30",
"last_updated": "2021-05-30",
"certification_date": "2021-05-30",
"status": "A"
},
"taxonomies": [
{
"code": "2084N0600X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Clinical Neurophysiology",
"state": "AZ",
"license": "0000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in West Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 30, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.