Healthcare Provider Details

I. General information

NPI: 1982692836
Provider Name (Legal Business Name): SHAILEN SHAH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CARNIE BLVD
VOORHEES NJ
08043-1548
US

IV. Provider business mailing address

401 ROUTE 73 N 40 LAKE CENTER DRIVE SUITE 201A
MARLTON NJ
08053-3425
US

V. Phone/Fax

Practice location:
  • Phone: 856-325-3328
  • Fax: 856-325-3276
Mailing address:
  • Phone: 856-355-0340
  • Fax: 856-355-0346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number25MA06779400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: