Provider Demographics
NPI:1780857995
Name:SHAH, CHHAYA BHADRESH
Entity Type:Individual
Prefix:MRS
First Name:CHHAYA
Middle Name:BHADRESH
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 SAINT GEORGE AVE
Mailing Address - Street 2:4B
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-2558
Mailing Address - Country:US
Mailing Address - Phone:732-318-2860
Mailing Address - Fax:
Practice Address - Street 1:872 SAINT GEORGE AVE
Practice Address - Street 2:4B
Practice Address - City:WOODBRIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07095-2558
Practice Address - Country:US
Practice Address - Phone:732-318-2860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ639572126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant