Provider Demographics
NPI:1497929673
Name:SHAH, PALLAVI DEVENDRA (MD)
Entity Type:Individual
Prefix:DR
First Name:PALLAVI
Middle Name:DEVENDRA
Last Name:SHAH
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 1:165 MORRIS TPKE
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-2807
Mailing Address - Country:US
Mailing Address - Phone:973-895-2529
Mailing Address - Fax:
Practice Address - Street 1:165 MORRIS TPKE
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-2807
Practice Address - Country:US
Practice Address - Phone:973-895-2529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA03860800207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine