Provider Demographics
NPI:1427374594
Name:SHAH, SHITAL P (DO)
Entity Type:Individual
Prefix:
First Name:SHITAL
Middle Name:P
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHITAL
Other - Middle Name:P
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4 BRIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07012-1664
Mailing Address - Country:US
Mailing Address - Phone:973-471-3680
Mailing Address - Fax:
Practice Address - Street 1:4 BRIGHTON RD
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07012-1664
Practice Address - Country:US
Practice Address - Phone:973-471-3680
Practice Address - Fax:973-471-6360
Is Sole Proprietor?:No
Enumeration Date:2010-04-14
Last Update Date:2019-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2789752084N0400X
NJ25MB106473002084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400125092Medicare PIN