Provider Demographics
NPI:1750464491
Name:SHAH, SHAILAJA K (MD)
Entity Type:Individual
Prefix:
First Name:SHAILAJA
Middle Name:K
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 OMNI DRIVE,
Mailing Address - Street 2:407 OMNI DRIVE
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844
Mailing Address - Country:US
Mailing Address - Phone:732-689-3832
Mailing Address - Fax:
Practice Address - Street 1:407 OMNI DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4527
Practice Address - Country:US
Practice Address - Phone:732-689-3832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA0712692084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ8489602Medicaid
NJ0023701OtherAGENCY MEDICAID PROVIDER
NJ527486OtherAGENCY MEDICARE NUMBER
047091Medicare ID - Type Unspecified
H34682Medicare UPIN