Provider Demographics
NPI:1053502013
Name:SHAH, PURVI DEEPAK (PHD)
Entity Type:Individual
Prefix:DR
First Name:PURVI
Middle Name:DEEPAK
Last Name:SHAH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2405 WHITNEY AVE
Mailing Address - Street 2:APT 306
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3235
Mailing Address - Country:US
Mailing Address - Phone:516-205-6080
Mailing Address - Fax:
Practice Address - Street 1:2405 WHITNEY AVE
Practice Address - Street 2:APT 306
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3235
Practice Address - Country:US
Practice Address - Phone:516-205-6080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016902103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical