Healthcare Provider Details

I. General information

NPI: 1053717215
Provider Name (Legal Business Name): NEAL SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2014
Last Update Date: 02/01/2025
Certification Date: 02/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STONY BROOK DERMATOLOGY ASSOCIATES 1320 STONY BROOK ROAD BUILDING F, SUITE 200
STONY BROOK NY
11790
US

IV. Provider business mailing address

STONY BROOK DERMATOLOGY ASSOCIATES 1320 STONY BROOK ROAD BUILDING F, SUITE 200
STONY BROOK NY
11790
US

V. Phone/Fax

Practice location:
  • Phone: 631-444-4200
  • Fax: 631-444-4276
Mailing address:
  • Phone: 631-444-4200
  • Fax: 631-444-4276

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP0008208
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number328334
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: