Provider Demographics
NPI:1023037116
Name:SHAH, DHANVANTI B (MD)
Entity Type:Individual
Prefix:
First Name:DHANVANTI
Middle Name:B
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 1:25 MULE RD
Mailing Address - Street 2:UNIT B4
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-5037
Mailing Address - Country:US
Mailing Address - Phone:732-341-0020
Mailing Address - Fax:732-341-0072
Practice Address - Street 1:25 MULE RD UNIT B4
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-5037
Practice Address - Country:US
Practice Address - Phone:732-341-0020
Practice Address - Fax:732-341-0072
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03965600207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ067431OtherMEDICARE PROVIDER #
NJ443668RHCMedicare ID - Type Unspecified
NJ067431OtherMEDICARE PROVIDER #