Provider Demographics
NPI:1447220579
Name:SHETH, NEHA P (OD)
Entity Type:Individual
Prefix:DR
First Name:NEHA
Middle Name:P
Last Name:SHETH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1129 NORTHERN BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MANHASSET
Mailing Address - State:NY
Mailing Address - Zip Code:11030-3045
Mailing Address - Country:US
Mailing Address - Phone:516-627-5656
Mailing Address - Fax:
Practice Address - Street 1:1129 NORTHERN BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3045
Practice Address - Country:US
Practice Address - Phone:516-627-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006989152W00000X
NJOA005989152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0076333Medicaid
096768Medicare ID - Type Unspecified
V07724Medicare UPIN