Provider Demographics
NPI:1336281823
Name:SHAH, NEEL (MD)
Entity Type:Individual
Prefix:DR
First Name:NEEL
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 1:26908 INDEPENDENCE WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3302
Mailing Address - Country:US
Mailing Address - Phone:315-629-4525
Mailing Address - Fax:315-629-4086
Practice Address - Street 1:1575 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-9371
Practice Address - Country:US
Practice Address - Phone:315-786-7300
Practice Address - Fax:315-786-7310
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24693207Q00000X
NY003297207Q00000X
NY268065207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine