Healthcare Provider Details

I. General information

NPI: 1710164140
Provider Name (Legal Business Name): MS. DINA SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 12/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W 21ST ST SUITE 1203
NEW YORK NY
10010-6904
US

IV. Provider business mailing address

317 E 34TH ST SUITE 901
NEW YORK NY
10016-4974
US

V. Phone/Fax

Practice location:
  • Phone: 212-352-0549
  • Fax:
Mailing address:
  • Phone: 212-425-8000
  • Fax: 212-203-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberF304478-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: