Provider Demographics
NPI:1013179894
Name:SHAH, MALA (MD)
Entity Type:Individual
Prefix:
First Name:MALA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 E 85TH ST
Mailing Address - Street 2:APT 29H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-2140
Mailing Address - Country:US
Mailing Address - Phone:631-827-7024
Mailing Address - Fax:
Practice Address - Street 1:185 E 85TH ST
Practice Address - Street 2:APT 29H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-2140
Practice Address - Country:US
Practice Address - Phone:631-827-7024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2677162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology