Provider Demographics
NPI:1346659802
Name:SHAH, NISHA (DPM)
Entity Type:Individual
Prefix:DR
First Name:NISHA
Middle Name:
Last Name:SHAH
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 1:750 S WHITE HORSE PIKE
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-2000
Mailing Address - Country:US
Mailing Address - Phone:609-567-0606
Mailing Address - Fax:609-567-2509
Practice Address - Street 1:750 S WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-2000
Practice Address - Country:US
Practice Address - Phone:609-567-0606
Practice Address - Fax:609-567-0606
Is Sole Proprietor?:No
Enumeration Date:2014-08-10
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00319900213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7820240002OtherDMERC
NJ1346659802OtherINDIVIDUAL NPI
NJ0736309Medicaid