Provider Demographics
NPI:1730108077
Name:MEHTA, SHASHIKANT J (MD)
Entity Type:Individual
Prefix:DR
First Name:SHASHIKANT
Middle Name:J
Last Name:MEHTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 HAMILTON BLVD
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-3630
Mailing Address - Country:US
Mailing Address - Phone:610-776-4377
Mailing Address - Fax:
Practice Address - Street 1:3110 HAMILTON BLVD
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-3630
Practice Address - Country:US
Practice Address - Phone:610-776-4377
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA 55739207R00000X
PAMD-047555-L207R00000X
FLMA 0067967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJMA-55739OtherNJ -STATE LICENSE.
PAMD-047555-LOtherPA-STATE LICENSE.
FLMA 0067967OtherFL-STATE LICENSE.
FLMA 0067967OtherFL-STATE LICENSE.