Provider Demographics
NPI:1629062161
Name:KENIA, SHANTILAL NANJI (MD, FACC)
Entity Type:Individual
Prefix:DR
First Name:SHANTILAL
Middle Name:NANJI
Last Name:KENIA
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 LADY SLIPPER CIR
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-4581
Mailing Address - Country:US
Mailing Address - Phone:413-977-6590
Mailing Address - Fax:413-562-0907
Practice Address - Street 1:27 LADY SLIPPER CIR
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-4581
Practice Address - Country:US
Practice Address - Phone:413-977-6590
Practice Address - Fax:413-562-0907
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA47638207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA052430OtherCONNECTICARE
MA13550OtherHEALTH NEW ENGLAND
MA6166385Medicaid
MABX9518OtherMEDICARE PTAN
MAJ02371OtherBCBS OF MASSACHUSETTS
MA060057516OtherRAILROAD MEDICARE
MA300110OtherHARVARD PILGRIM HEALTHCAR
MA047638OtherTUFTS
MA98128301OtherNETWORK HEALTH
MAJ02371OtherBCBS OF MASSACHUSETTS
MAB74257Medicare UPIN