Healthcare Provider Details

I. General information

NPI: 1730408048
Provider Name (Legal Business Name): SHAILI NIRANJAN SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2010
Last Update Date: 06/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24 VREELAND DR STE 1
SKILLMAN NJ
08558-2621
US

IV. Provider business mailing address

24 VREELAND DR STE 1
SKILLMAN NJ
08558-2621
US

V. Phone/Fax

Practice location:
  • Phone: 609-921-2202
  • Fax: 609-924-1468
Mailing address:
  • Phone: 609-921-2202
  • Fax: 609-924-1468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number25MA09884200
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: