Healthcare Provider Details

I. General information

NPI: 1386533719
Provider Name (Legal Business Name): JAHNVI NAYANKUMAR SHAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 SOUTH AVE STE 103
STATEN ISLAND NY
10314-3428
US

IV. Provider business mailing address

900 SOUTH AVE STE 103
STATEN ISLAND NY
10314-3428
US

V. Phone/Fax

Practice location:
  • Phone: 718-226-5619
  • Fax:
Mailing address:
  • Phone: 718-226-5619
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number012334
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: