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General NPI Number Information
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NPI Number | 1205924974
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Entity Type | Individual
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Provider Name | SUDHA R SHAH
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Gender | Female
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 03/01/2012
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Provider Practice Location Address
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Address Line | 3860 KINGS HWY
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City | BROOKLYN
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State | NY
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Zip | 11234-2907
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Country | US
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Telephone | 718-252-5550
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Fax | 718-258-1768
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Provider Business Mailing Address
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Address Line | 288 BIRCH DR
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City | ROSLYN
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State | NY
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Zip | 11576-3002
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Country | US
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Telephone | 516-567-6135
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Fax | 718-258-1768
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 133672
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License Number State | NY
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