Healthcare Provider Details

I. General information

NPI: 1124557418
Provider Name (Legal Business Name): HELI SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2017
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT STREET
BOSTON MA
02114
US

IV. Provider business mailing address

55 FRUIT STREET
BOSTON MA
02114
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-7972
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLP04013
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberME168156
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number1015859
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: