MEDICARE: DITI SHAH PA

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	363AM0700X	Medical Physician Assistant	026054	NY

General Provider Information

NPI Number	:	1578153193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DITI SHAH PA

Provider Business Mailing Address
First Line	:	100 E 77TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10075-1850
Country	:	US
Telephone Number	:	212-434-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	PO BOX 1086
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10029-0311
Country	:	US
Telephone Number	:	212-241-1653
Fax Number	:

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

Provider Enumeration Date	:	01/19/2021
Last Update Date	:	11/08/2024

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Directions to “ DITI SHAH PA” Practice Location

Language	Start Address	Practice Location

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