MEDICARE: DR. NIKESH SHAH DO

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	2084P0800X	Psychiatry Physician	326538	NY
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1407591365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKESH SHAH DO

Provider Business Mailing Address
First Line	:	4802 10TH AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11219-2916
Country	:	US
Telephone Number	:
Fax Number	:	516-461-4957

Provider Business Practice Location Address
First Line	:	MAIMONIDES MEDICAL CENTER
Second Line	:	4802 10TH AVENUE
City	:	BROOKLYN
State	:	NY
Zip	:	11219
Country	:	US
Telephone Number	:	718-283-6000
Fax Number	:

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

Provider Enumeration Date	:	05/04/2022
Last Update Date	:	03/13/2026

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