Provider Demographics
NPI:1538491923
Name:SHAH, BHUMI A
Entity Type:Individual
Prefix:MS
First Name:BHUMI
Middle Name:A
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4510 50TH AVE APT 1B
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-7008
Mailing Address - Country:US
Mailing Address - Phone:718-729-2860
Mailing Address - Fax:
Practice Address - Street 1:4510 50TH AVE APT 1B
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-7008
Practice Address - Country:US
Practice Address - Phone:718-729-2860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2010-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053960183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist