Provider Demographics
NPI:1336122795
Name:PANDYA SHAH, SHRIDEVI NAVINCHANDRA (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHRIDEVI
Middle Name:NAVINCHANDRA
Last Name:PANDYA SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 HARTLANDER ST
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-2668
Mailing Address - Country:US
Mailing Address - Phone:973-972-5255
Mailing Address - Fax:
Practice Address - Street 1:53 HARTLANDER ST
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-2668
Practice Address - Country:US
Practice Address - Phone:973-972-5255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07521400207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0003646Medicaid
NY02666695Medicaid
NY02666695Medicaid
H82108Medicare UPIN