Healthcare Provider Details

I. General information

NPI: 1255743365
Provider Name (Legal Business Name): SHILPA MEHTA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2014
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BROOKDALE PLZ
BROOKLYN NY
11212-3139
US

IV. Provider business mailing address

1 ELM ST APT 5-B
TUCKAHOE NY
10707-3919
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-5893
  • Fax:
Mailing address:
  • Phone: 917-715-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number292856-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: