Provider Demographics
NPI:1629517065
Name:SHAH, SHYAMLI (MA)
Entity Type:Individual
Prefix:
First Name:SHYAMLI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 BOND ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-2454
Mailing Address - Country:US
Mailing Address - Phone:908-500-2574
Mailing Address - Fax:
Practice Address - Street 1:254B MOUNTAIN AVE STE 300
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2413
Practice Address - Country:US
Practice Address - Phone:908-852-5858
Practice Address - Fax:908-704-1790
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0023701Medicaid