MEDICARE: TUSHIN ATULKUMAR 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	122300000X	Dentist	11626	CT
2	122300000X	Dentist	04163	NH
3	390200000X	Student in an Organized Health Care Education/Training Program
4	122300000X	Dentist	DN1857506	MA

General Provider Information

NPI Number	:	1649651670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TUSHIN ATULKUMAR SHAH

Provider Business Mailing Address
First Line	:	764 SHAKER RD
Second Line	:
City	:	LONGMEADOW
State	:	MA
Zip	:	01106-2421
Country	:	US
Telephone Number	:	724-261-1034
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 N MAIN ST
Second Line	:
City	:	EAST LONGMEADOW
State	:	MA
Zip	:	01028-1834
Country	:	US
Telephone Number	:	413-467-9600
Fax Number	:

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

Provider Enumeration Date	:	06/16/2015
Last Update Date	:	10/18/2021

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Directions to “ TUSHIN ATULKUMAR SHAH ” Practice Location

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