MEDICARE: SANDEEP SHAH MD

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	208000000X	Pediatrics Physician	25MA09103700	NJ
2	208M00000X	Hospitalist Physician	25MA09103700	NJ

General Provider Information

NPI Number	:	1225314966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDEEP SHAH MD

Provider Business Mailing Address
First Line	:	1906 PATERSON PLANK RD
Second Line	:	APT #3A
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-1902
Country	:	US
Telephone Number	:	561-389-0319
Fax Number	:

Provider Business Practice Location Address
First Line	:	1906 PATERSON PLANK RD
Second Line	:	APT #3A
City	:	NORTH BERGEN
State	:	NJ
Zip	:	07047-1902
Country	:	US
Telephone Number	:	561-389-0319
Fax Number	:

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

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	04/18/2019

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Directions to “ SANDEEP SHAH MD” Practice Location

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