Provider Demographics
NPI:1225516305
Name:DARSHAN J SHAH MD LLC
Entity Type:Organization
Organization Name:DARSHAN J SHAH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:PINKI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-763-0208
Mailing Address - Street 1:139 HAZARD AVE
Mailing Address - Street 2:BLDG #4
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082
Mailing Address - Country:US
Mailing Address - Phone:860-763-0208
Mailing Address - Fax:860-763-0224
Practice Address - Street 1:139 HAZARD AVE
Practice Address - Street 2:BLDG #4
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082
Practice Address - Country:US
Practice Address - Phone:860-783-0208
Practice Address - Fax:860-763-0224
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DARSHAN J SHAH MD LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001390133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty