Provider Demographics
NPI:1619315223
Name:SHAH, MIHIR J (PSYD)
Entity Type:Individual
Prefix:
First Name:MIHIR
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:MIHIR
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:2100 ROUTE 33
Mailing Address - Street 2:SUITE 9 & 10
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-988-1443
Mailing Address - Fax:
Practice Address - Street 1:2100 ROUTE 33
Practice Address - Street 2:SUITE 9-10
Practice Address - City:NEPTUNE
Practice Address - State:NJ
Practice Address - Zip Code:07753-6102
Practice Address - Country:US
Practice Address - Phone:732-988-3441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103G00000X, 103G00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program