Provider Demographics
NPI:1003896564
Name:SHAH, BHADRA B (MD)
Entity Type:Individual
Prefix:DR
First Name:BHADRA
Middle Name:B
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:BHADRA
Other - Middle Name:K
Other - Last Name:SHROFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:303 SECOND AVE
Mailing Address - Street 2:SUITE 9
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-2746
Mailing Address - Country:US
Mailing Address - Phone:212-777-3920
Mailing Address - Fax:212-614-9376
Practice Address - Street 1:303 SECOND AVE
Practice Address - Street 2:SUITE 9
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-2746
Practice Address - Country:US
Practice Address - Phone:212-777-3920
Practice Address - Fax:212-614-9376
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111592207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY002011343Medicaid
NY964431OtherBCBS
NY002011343Medicaid
C12495Medicare ID - Type Unspecified