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: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 HILL BLVD STE 104
JEFFERSON VALLEY NY
10535-1503
US

IV. Provider business mailing address

8 CROSS RIVER RD
MOUNT KISCO NY
10549-4036
US

V. Phone/Fax

Practice location:
  • Phone: 917-715-9115
  • Fax: 585-304-7622
Mailing address:
  • Phone: 917-715-9115
  • Fax: 585-304-7622

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: