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General NPI Number Information
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NPI Number | 1659330314
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Entity Type | Individual
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Provider Name | PUNITA A SHAH LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/21/2006
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 1313 HOLLY HILL RD
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City | VESTAL
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State | NY
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Zip | 13850-5331
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Country | US
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Telephone | 607-222-4031
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Fax | 607-289-2469
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Provider Business Mailing Address
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Address Line | PO BOX 947
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City | VESTAL
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State | NY
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Zip | 13851-0947
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Country | US
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Telephone | 607-786-0435
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Fax | 607-786-0435
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 057320
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License Number State | NY
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