Provider Demographics
NPI:1679912778
Name:SHAHA, DAVID PATRICK (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:PATRICK
Last Name:SHAHA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HAWKINS DR
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52242-1009
Mailing Address - Country:US
Mailing Address - Phone:319-356-2572
Mailing Address - Fax:319-356-4505
Practice Address - Street 1:330 S GARDEN WAY STE 390
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-8179
Practice Address - Country:US
Practice Address - Phone:541-683-3325
Practice Address - Fax:541-343-4117
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116026310207Q00000X
IAMD-481252084S0012X, 207Q00000X
ORMD219256207QS1201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine