Provider Demographics
NPI:1326012410
Name:SHAH, CANDICE E (MD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:E
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:E
Other - Last Name:PANARELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1673 S STATE ST
Mailing Address - Street 2:STE A
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-5148
Mailing Address - Country:US
Mailing Address - Phone:302-724-5125
Mailing Address - Fax:302-380-4778
Practice Address - Street 1:1673 S STATE ST STE A
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5148
Practice Address - Country:US
Practice Address - Phone:302-724-5125
Practice Address - Fax:302-380-4778
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2017-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0008211207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0042790Medicaid
NJ071438RU6Medicare ID - Type Unspecified
NJ0042790Medicaid