MEDICARE: DR. KINNI K SHAH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	054911	NY

General Provider Information

NPI Number	:	1174838007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KINNI K SHAH

Provider Business Mailing Address
First Line	:	549 E 234TH ST APT 1N
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10470-2454
Country	:	US
Telephone Number	:	718-304-7701
Fax Number	:

Provider Business Practice Location Address
First Line	:	3513 WHITE PLAINS RD
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10467-5705
Country	:	US
Telephone Number	:	718-231-2471
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/16/2010
Last Update Date	:	08/16/2010

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Directions to “ DR. KINNI K SHAH ” Practice Location

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