Healthcare Provider Details

I. General information

NPI: 1164336350
Provider Name (Legal Business Name): BHUMI SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 PRINCESS DR
NORTH BRUNSWICK NJ
08902-4104
US

IV. Provider business mailing address

25 PRINCESS DR
NORTH BRUNSWICK NJ
08902-4104
US

V. Phone/Fax

Practice location:
  • Phone: 570-687-4834
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number26NJ15666300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: