Provider Demographics
NPI:1164878310
Name:SHAH, SUNIL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 ST. ANDREWS LANE
Mailing Address - Street 2:GLEN COVE HOSPITAL
Mailing Address - City:GLEN COVE
Mailing Address - State:NY
Mailing Address - Zip Code:11542
Mailing Address - Country:US
Mailing Address - Phone:516-674-7300
Mailing Address - Fax:516-674-7374
Practice Address - Street 1:101 ST. ANDREWS LANE
Practice Address - Street 2:GLEN COVE HOSPITAL
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542
Practice Address - Country:US
Practice Address - Phone:516-674-7631
Practice Address - Fax:516-674-7639
Is Sole Proprietor?:No
Enumeration Date:2016-05-06
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY299557208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist