Healthcare Provider Details

I. General information

NPI: 1902509177
Provider Name (Legal Business Name): KRISTINA CHANDAN SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2023
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 YOUNG AVE STE 380A
MOORESTOWN NJ
08057-3130
US

IV. Provider business mailing address

301 LIPPINCOTT DR STE 410
MARLTON NJ
08053-4197
US

V. Phone/Fax

Practice location:
  • Phone: 856-291-8650
  • Fax: 856-291-8654
Mailing address:
  • Phone: 856-291-8650
  • Fax: 856-291-8654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number25MA13088100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: