Healthcare Provider Details

I. General information

NPI: 1821762550
Provider Name (Legal Business Name): AMY SHAH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2021
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 E 23RD ST
NEW YORK NY
10010-5011
US

IV. Provider business mailing address

245 E 84TH ST APT 20A
NEW YORK NY
10028-2995
US

V. Phone/Fax

Practice location:
  • Phone: 212-686-7500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number009432
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: