Healthcare Provider Details

I. General information

NPI: 1801704796
Provider Name (Legal Business Name): UTKARSH SHAH RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 FRANKLIN AVE
VALLEY STREAM NY
11580-2145
US

IV. Provider business mailing address

921 LAKEVILLE RD
NEW HYDE PARK NY
11040-3008
US

V. Phone/Fax

Practice location:
  • Phone: 718-313-7535
  • Fax:
Mailing address:
  • Phone: 718-313-7535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number699001
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: