Provider Demographics
NPI:1225154388
Name:SHAH, NILA A (MD)
Entity Type:Individual
Prefix:DR
First Name:NILA
Middle Name:A
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:NILA
Other - Middle Name:M
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:68 W CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1300
Mailing Address - Country:US
Mailing Address - Phone:845-473-2122
Mailing Address - Fax:845-471-1385
Practice Address - Street 1:68 W CEDAR ST
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-1300
Practice Address - Country:US
Practice Address - Phone:845-473-2122
Practice Address - Fax:845-471-1385
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY121811-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY14A901Medicare ID - Type Unspecified