Provider Demographics
NPI:1629517925
Name:SHAH, HENNA S (APN)
Entity Type:Individual
Prefix:MRS
First Name:HENNA
Middle Name:S
Last Name:SHAH
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:DIMPLE
Other - Middle Name:N
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APN
Mailing Address - Street 1:1 BRIDGE AVE APT 201
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1537
Mailing Address - Country:US
Mailing Address - Phone:248-925-0923
Mailing Address - Fax:
Practice Address - Street 1:107 MONMOUTH RD STE 102
Practice Address - Street 2:
Practice Address - City:WEST LONG BRANCH
Practice Address - State:NJ
Practice Address - Zip Code:07764-1021
Practice Address - Country:US
Practice Address - Phone:732-641-3350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-20
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR18059800163W00000X
NJ26NJ00724700363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse