Healthcare Provider Details

I. General information

NPI: 1437438256
Provider Name (Legal Business Name): NILAY G SHAH DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 STATE ROUTE 32
HIGHLAND MILLS NY
10930-5200
US

IV. Provider business mailing address

70 MITCHELL AVE
POUGHKEEPSIE NY
12603-3423
US

V. Phone/Fax

Practice location:
  • Phone: 845-928-3348
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0555691
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: