Provider Demographics
NPI:1235125311
Name:MEHTA, SHREYA (DPM)
Entity Type:Individual
Prefix:DR
First Name:SHREYA
Middle Name:
Last Name:MEHTA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 PARK ST
Mailing Address - Street 2:
Mailing Address - City:UPPER MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-2239
Mailing Address - Country:US
Mailing Address - Phone:973-748-9330
Mailing Address - Fax:973-748-6985
Practice Address - Street 1:379 PARK ST
Practice Address - Street 2:
Practice Address - City:UPPER MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-2239
Practice Address - Country:US
Practice Address - Phone:973-748-9330
Practice Address - Fax:973-748-6985
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00264000213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8537101Medicaid
NJU85703Medicare UPIN
NJ049113SFQMedicare ID - Type Unspecified