Basic Information
| Provider Information | |||||||||
| NPI: | 1316175433 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMBANI | ||||||||
| FirstName: | SHOSHANA | ||||||||
| MiddleName: | WOO | ||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | WOO | ||||||||
| OtherFirstName: | SHOSHANA | ||||||||
| OtherMiddleName: | LARA | ||||||||
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| OtherCredential: | M.D. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2 HOT METAL ST | ||||||||
| Address2: | QUANTUM ONE | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152032348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126473087 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3380 BLVD OF ALLIES | ||||||||
| Address2: | UPP DIV PLASTIC SURGERY, SUITE 158 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152133125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776399688 | ||||||||
| FaxNumber: | 4126411149 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2009 | ||||||||
| LastUpdateDate: | 04/20/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | 4301094278 | MI | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 390200000X | MD458694 | PA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 208200000X | MD458694 | PA | Y | Allopathic & Osteopathic Physicians | Plastic Surgery | 208200000X | 4301094278 | MI | N | Allopathic & Osteopathic Physicians | Plastic Surgery |
No ID Information.