MEDICARE: MR. MAYUR J SHAH R.PH

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	037039	NY

General Provider Information

NPI Number	:	1336259423
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MAYUR J SHAH R.PH

Provider Business Mailing Address
First Line	:	32 CASEY LN
Second Line	:
City	:	MOUNT SINAI
State	:	NY
Zip	:	11766-2353
Country	:	US
Telephone Number	:	631-928-2687
Fax Number	:	631-732-0013

Provider Business Practice Location Address
First Line	:	249 MIDDLE COUNTRY RD
Second Line	:
City	:	SELDEN
State	:	NY
Zip	:	11784-2516
Country	:	US
Telephone Number	:	631-732-7373
Fax Number	:	631-732-0013

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	07/08/2007

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