Provider Demographics
NPI:1760692941
Name:SHAH, PURVI (MD)
Entity Type:Individual
Prefix:
First Name:PURVI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:107 NEWTOWN RD
Mailing Address - Street 2:1B
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-4146
Mailing Address - Country:US
Mailing Address - Phone:203-748-7433
Mailing Address - Fax:203-790-5324
Practice Address - Street 1:107 NEWTOWN RD
Practice Address - Street 2:1B
Practice Address - City:DANBURY
Practice Address - State:CT
Practice Address - Zip Code:06810-4146
Practice Address - Country:US
Practice Address - Phone:203-748-7433
Practice Address - Fax:203-790-5324
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT045246174400000X, 207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP00443560Medicare PIN
CT030000141Medicare PIN