Provider Demographics
NPI:1013197300
Name:SHAH, BHAKTI (RPA-C)
Entity Type:Individual
Prefix:MRS
First Name:BHAKTI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:RPA-C
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Other - Credentials:
Mailing Address - Street 1:374 STOCKHOLM ST
Mailing Address - Street 2:C/O FACULTY PRACTICE MANAGEMENT-SUITE I37N
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11237-4006
Mailing Address - Country:US
Mailing Address - Phone:914-654-6543
Mailing Address - Fax:914-654-0454
Practice Address - Street 1:374 STOCKHOLM ST
Practice Address - Street 2:C/O FACULTY PRACTICE MANAGEMENT-SUITE I37N
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11237-4006
Practice Address - Country:US
Practice Address - Phone:914-654-6543
Practice Address - Fax:914-654-0454
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2016-03-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY5656732781Medicare PIN