MEDICARE: MINESH 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	034932	NY

General Provider Information

NPI Number	:	1417289554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINESH K. SHAH

Provider Business Mailing Address
First Line	:	6924 260TH PL
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11004-1010
Country	:	US
Telephone Number	:	718-343-5806
Fax Number	:

Provider Business Practice Location Address
First Line	:	104 DEKALB AVE
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11201-5427
Country	:	US
Telephone Number	:	718-250-0060
Fax Number	:	718-852-0469

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

Provider Enumeration Date	:	01/30/2010
Last Update Date	:	01/30/2010

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Directions to “ MINESH K. SHAH ” Practice Location

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