Provider Demographics
NPI:1528534344
Name:SHAH, RADHIKA
Entity Type:Individual
Prefix:
First Name:RADHIKA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RADHIKA
Other - Middle Name:
Other - Last Name:MANIAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:196 HOLMES WAY
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-5738
Mailing Address - Country:US
Mailing Address - Phone:646-671-0418
Mailing Address - Fax:
Practice Address - Street 1:300 S MCLEAN BLVD STE M
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60123-1023
Practice Address - Country:US
Practice Address - Phone:224-535-8515
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.031707122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist