MEDICARE: DR. SHILPA PRABODH MEHTA MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	C10007004	DE
2	208000000X	Pediatrics Physician	C10007004	DE

General Provider Information

NPI Number	:	1447236773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHILPA PRABODH MEHTA MD

Provider Business Mailing Address
First Line	:	1400 PEOPLES PLZ
Second Line	:	SUITE 201
City	:	NEWARK
State	:	DE
Zip	:	19702-5707
Country	:	US
Telephone Number	:	302-392-2200
Fax Number	:	302-392-2226

Provider Business Practice Location Address
First Line	:	1400 PEOPLES PLZ
Second Line	:	SUITE 201
City	:	NEWARK
State	:	DE
Zip	:	19702-5707
Country	:	US
Telephone Number	:	302-392-2200
Fax Number	:	302-392-2226

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	01/31/2008

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