Healthcare Provider Details

I. General information

NPI: 1184207425
Provider Name (Legal Business Name): SHIVANI SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 OLD HOOK RD STE 101
WESTWOOD NJ
07675-3247
US

IV. Provider business mailing address

3 UNIVERSITY PLZ STE 205
HACKENSACK NJ
07601-6208
US

V. Phone/Fax

Practice location:
  • Phone: 201-358-0400
  • Fax: 201-358-6114
Mailing address:
  • Phone: 201-833-3599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA12607500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: