Provider Demographics
NPI:1093875064
Name:SHAH, KEYUR N (BS)
Entity Type:Individual
Prefix:
First Name:KEYUR
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23040 88TH AVE
Mailing Address - Street 2:
Mailing Address - City:QUEENS VILLAGE
Mailing Address - State:NY
Mailing Address - Zip Code:11427-2608
Mailing Address - Country:US
Mailing Address - Phone:516-784-6886
Mailing Address - Fax:
Practice Address - Street 1:16502 BAISLEY BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-2517
Practice Address - Country:US
Practice Address - Phone:718-525-7642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist