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General NPI Number Information
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NPI Number | 1245850221
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Entity Type | Individual
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Provider Name | DHARA B SHAH DPM
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Gender | Female
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Dates
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Enumeration Date | 04/20/2020
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Last Update Date | 04/08/2023
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Provider Practice Location Address
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Address Line | 3003 NEW HYDE PARK RD STE 312
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1214
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Country | US
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Telephone | 866-322-7691
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Fax |
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Provider Business Mailing Address
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Address Line | 3003 NEW HYDE PARK RD STE 312
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City | NEW HYDE PARK
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State | NY
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Zip | 11042-1214
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Country | US
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Telephone |
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | N007245
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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