Provider Demographics
NPI:1477781672
Name:SHAH, SUNNY NIRANJAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNNY
Middle Name:NIRANJAN
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 13749
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19101-3749
Mailing Address - Country:US
Mailing Address - Phone:855-447-2240
Mailing Address - Fax:302-733-0854
Practice Address - Street 1:350 N WALL ST
Practice Address - Street 2:
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-2901
Practice Address - Country:US
Practice Address - Phone:815-933-1671
Practice Address - Fax:815-935-7867
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2013-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036132035207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL6951025Medicare PIN