Provider Demographics
NPI:1043394596
Name:SHAH, KISHORI P (MD)
Entity Type:Individual
Prefix:MRS
First Name:KISHORI
Middle Name:P
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:354 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-3317
Mailing Address - Country:US
Mailing Address - Phone:845-486-0420
Mailing Address - Fax:845-486-9444
Practice Address - Street 1:354 MAIN ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-3317
Practice Address - Country:US
Practice Address - Phone:845-486-0420
Practice Address - Fax:845-486-9444
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY201599207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY43852OtherGHI/HMO
NY01713813Medicaid
NY100146373401OtherUNITED HEALTHCARE
NY2085557OtherAETNA
NY21997OtherHUDSON HEALTH PLAN
NYP874375OtherOXFORD
NY087220OtherMVP
NY5901827OtherGHI/PPO
NY75X881OtherEMPIRE BC/BS
NY10068286OtherCDPHP
NY4C1782OtherHEALTHNET
NY087220OtherMVP
NY4C1782OtherHEALTHNET