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General NPI Number Information
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NPI Number | 1245579226
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Entity Type | Individual
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Provider Name | SHIVANI S SHAH M.D
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Gender | Female
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Dates
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Enumeration Date | 02/11/2013
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 135 CANAL ST STE 200
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City | STATEN ISLAND
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State | NY
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Zip | 10304
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Country | US
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Telephone | 917-830-1950
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Fax |
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Provider Business Mailing Address
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Address Line | 46 ALBION ST
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City | BRIDGEPORT
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State | CT
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Zip | 06605-2602
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Country | US
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Telephone | 646-724-0532
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Fax |
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 292168
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 292168
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License Number State | NY
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