Provider Demographics
NPI:1497792121
Name:SHAH, SUNIL CHANDRA (M,D)
Entity Type:Individual
Prefix:DR
First Name:SUNIL
Middle Name:CHANDRA
Last Name:SHAH
Suffix:
Gender:M
Credentials:M,D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 GATHERING ROAD
Mailing Address - Street 2:
Mailing Address - City:PINEBROOK
Mailing Address - State:NJ
Mailing Address - Zip Code:07058
Mailing Address - Country:US
Mailing Address - Phone:973-278-9023
Mailing Address - Fax:973-977-6761
Practice Address - Street 1:52 13TH AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504-1544
Practice Address - Country:US
Practice Address - Phone:073-278-9023
Practice Address - Fax:973-977-6761
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ29587207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ2945509Medicaid
NJSH74530Medicare ID - Type Unspecified
D18484Medicare UPIN