Provider Demographics
NPI:1578525432
Name:SHAH, SHEFALI A (DO)
Entity Type:Individual
Prefix:
First Name:SHEFALI
Middle Name:A
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:404 LIPPINCOTT DR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4112
Mailing Address - Country:US
Mailing Address - Phone:856-782-3300
Mailing Address - Fax:856-504-8029
Practice Address - Street 1:150 LAKESIDE BLVD
Practice Address - Street 2:
Practice Address - City:LANDING
Practice Address - State:NJ
Practice Address - Zip Code:07850-1119
Practice Address - Country:US
Practice Address - Phone:973-398-6300
Practice Address - Fax:973-398-6399
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2021-12-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJMB070675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8319006Medicaid
NJG45953Medicare UPIN
NJ040666DSVMedicare ID - Type Unspecified