Provider Demographics
NPI:1225314966
Name:SHAH, SANDEEP (MD)
Entity Type:Individual
Prefix:
First Name:SANDEEP
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 1:1906 PATERSON PLANK RD
Mailing Address - Street 2:APT #3A
Mailing Address - City:NORTH BERGEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07047-1902
Mailing Address - Country:US
Mailing Address - Phone:561-389-0319
Mailing Address - Fax:
Practice Address - Street 1:1906 PATERSON PLANK RD
Practice Address - Street 2:APT #3A
Practice Address - City:NORTH BERGEN
Practice Address - State:NJ
Practice Address - Zip Code:07047-1902
Practice Address - Country:US
Practice Address - Phone:561-389-0319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-26
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA09103700208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No208000000XAllopathic & Osteopathic PhysiciansPediatrics