Healthcare Provider Details

I. General information

NPI: 1528269040
Provider Name (Legal Business Name): TANA SHAH PRADHAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TANA ROHIT SHAH D.O.

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PATROON CREEK BLVD
ALBANY NY
12206-5013
US

IV. Provider business mailing address

449 ROUTE 146 STE 101
HALFMOON NY
12065-3239
US

V. Phone/Fax

Practice location:
  • Phone: 518-801-0725
  • Fax: 518-557-1295
Mailing address:
  • Phone: 518-373-3800
  • Fax: 518-373-3808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number25MB08307600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number253286
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: