Provider Demographics
NPI:1821118308
Name:SHAH, SEJAL PRAFUL (MSPT)
Entity Type:Individual
Prefix:
First Name:SEJAL
Middle Name:PRAFUL
Last Name:SHAH
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 E 3RD ST APT 6C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-7770
Mailing Address - Country:US
Mailing Address - Phone:917-855-3070
Mailing Address - Fax:
Practice Address - Street 1:176 E 3RD ST APT 6C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10009-7770
Practice Address - Country:US
Practice Address - Phone:917-855-3070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024228-12251P0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2251P0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistPediatrics