Healthcare Provider Details

I. General information

NPI: 1457526055
Provider Name (Legal Business Name): NISHANT C SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 UNIVERSITY DR DIV OF PED CARDIOLOGY PENN STATE CHILD HOSP
HERSHEY PA
17033-2360
US

IV. Provider business mailing address

500 UNIVERSITY DR PO BOX 850, DIV OF PED CARDIOLOGY PENN STATE CHILD HOSP
HERSHEY PA
17033-2360
US

V. Phone/Fax

Practice location:
  • Phone: 717-531-2050
  • Fax: 717-531-5380
Mailing address:
  • Phone: 717-531-2050
  • Fax: 717-531-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number4301088163
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License NumberMD441748
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: