Provider Demographics
NPI:1447403332
Name:NIMISH SHAH PSYCHIATRIC SERVICES LLC
Entity Type:Organization
Organization Name:NIMISH SHAH PSYCHIATRIC SERVICES LLC
Other - Org Name:TELE-THERAPEUTICS
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NIMISH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, CNS-BC
Authorized Official - Phone:508-834-3183
Mailing Address - Street 1:463 WORCESTER RD
Mailing Address - Street 2:SUITE 401
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5356
Mailing Address - Country:US
Mailing Address - Phone:508-834-3183
Mailing Address - Fax:508-532-1168
Practice Address - Street 1:463 WORCESTER RD
Practice Address - Street 2:SUITE 401
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5354
Practice Address - Country:US
Practice Address - Phone:508-834-3183
Practice Address - Fax:508-532-1168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230874364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Single Specialty