Provider Demographics
NPI:1497909782
Name:SHAH, URSULA PANKAJ (OTR)
Entity Type:Individual
Prefix:MS
First Name:URSULA
Middle Name:PANKAJ
Last Name:SHAH
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 DEARBORN DR
Mailing Address - Street 2:
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1276
Mailing Address - Country:US
Mailing Address - Phone:732-778-6854
Mailing Address - Fax:
Practice Address - Street 1:18 DEARBORN DR
Practice Address - Street 2:
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1276
Practice Address - Country:US
Practice Address - Phone:732-778-6854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ46TR00197600225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics