Provider Demographics
NPI:1447236773
Name:MEHTA, SHILPA PRABODH (MD)
Entity Type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:PRABODH
Last Name:MEHTA
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 1:1400 PEOPLES PLZ
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-5707
Mailing Address - Country:US
Mailing Address - Phone:302-392-2200
Mailing Address - Fax:302-392-2226
Practice Address - Street 1:1400 PEOPLES PLZ
Practice Address - Street 2:SUITE 201
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5707
Practice Address - Country:US
Practice Address - Phone:302-392-2200
Practice Address - Fax:302-392-2226
Is Sole Proprietor?:No
Enumeration Date:2005-12-19
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10007004207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G86656Medicare UPIN