Healthcare Provider Details

I. General information

NPI: 1427011782
Provider Name (Legal Business Name): DHIREN K SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3085 HARLEM ROAD SUITE 100
CHEEKTOWAGA NY
14225
US

IV. Provider business mailing address

3085 HARLEM RD SUITE 350
CHEEKTOWAGA NY
14225-2591
US

V. Phone/Fax

Practice location:
  • Phone: 716-844-5500
  • Fax: 716-844-5550
Mailing address:
  • Phone: 716-844-5500
  • Fax: 716-844-5550

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number200420
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: