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General NPI Number Information
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NPI Number | 1710204086
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Entity Type | Individual
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Provider Name | PAYAL K SHAH M.D
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Gender | Female
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Dates
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Enumeration Date | 04/27/2010
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Last Update Date | 10/15/2022
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Provider Practice Location Address
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Address Line | 318 MAIN ST STE 101A
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City | MILLBURN
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State | NJ
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Zip | 07041-1181
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Country | US
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Telephone | 973-888-9172
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Fax |
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Provider Business Mailing Address
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Address Line | 318 MAIN ST STE 101A
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City | MILLBURN
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State | NJ
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Zip | 07041-1181
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Country | US
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Telephone | 973-888-9172
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 269041
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 25MA09960000
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License Number State | NJ
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