Provider Demographics
NPI:1588184709
Name:SHAH, SNEHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SNEHA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 GARNET TER
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-2301
Mailing Address - Country:US
Mailing Address - Phone:973-533-0058
Mailing Address - Fax:
Practice Address - Street 1:15148 N DALE MABRY HWY
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33618-1817
Practice Address - Country:US
Practice Address - Phone:813-855-3510
Practice Address - Fax:813-265-8126
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI027143001223S0112X
NJ390200000X
FLDN274061223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program