Healthcare Provider Details

I. General information

NPI: 1629009923
Provider Name (Legal Business Name): SAPNA R SHAH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 8TH AVE SUITE 303
NEW YORK NY
10036-7000
US

IV. Provider business mailing address

780 8TH AVE SUITE 303
NEW YORK NY
10036-7000
US

V. Phone/Fax

Practice location:
  • Phone: 212-641-4500
  • Fax: 212-641-4508
Mailing address:
  • Phone: 212-641-4500
  • Fax: 212-641-4508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number216230
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: