Provider Demographics
NPI:1811597925
Name:SHAH, VAIDAHI
Entity Type:Individual
Prefix:
First Name:VAIDAHI
Middle Name:
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 1:28 LONGVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE HIAWATHA
Mailing Address - State:NJ
Mailing Address - Zip Code:07034-1710
Mailing Address - Country:US
Mailing Address - Phone:973-873-3333
Mailing Address - Fax:
Practice Address - Street 1:26 HAMPTON HOUSE RD
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:NJ
Practice Address - Zip Code:07860-1409
Practice Address - Country:US
Practice Address - Phone:973-300-4760
Practice Address - Fax:973-300-5284
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RIO3742100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist