Healthcare Provider Details

I. General information

NPI: 1982130100
Provider Name (Legal Business Name): KRINA SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2017
Last Update Date: 12/01/2023
Certification Date: 12/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 SOUTH ST STE 250
MORRISTOWN NJ
07960-6477
US

IV. Provider business mailing address

435 SOUTH ST STE 250
MORRISTOWN NJ
07960-6477
US

V. Phone/Fax

Practice location:
  • Phone: 973-971-5227
  • Fax:
Mailing address:
  • Phone: 973-971-5227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number26NJ00726600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: