Provider Demographics
NPI:1598379232
Name:SHAH, SNEHA TAPAN
Entity Type:Individual
Prefix:
First Name:SNEHA
Middle Name:TAPAN
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 1:8850 NEWBURGH RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3425
Mailing Address - Country:US
Mailing Address - Phone:734-524-9663
Mailing Address - Fax:734-524-9670
Practice Address - Street 1:8850 NEWBURGH RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48150-3425
Practice Address - Country:US
Practice Address - Phone:734-524-9663
Practice Address - Fax:734-524-9670
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302043409183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist