Provider Demographics
NPI:1821169640
Name:SHAH, CHANDRAVADEN C (MD)
Entity Type:Individual
Prefix:
First Name:CHANDRAVADEN
Middle Name:C
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BELLAMY LOOP
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10475-3702
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:140 BELLAMY LOOP
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10475-3702
Practice Address - Country:US
Practice Address - Phone:718-671-6600
Practice Address - Fax:718-671-6600
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113774207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1000207694Medicaid
NY2599923OtherGHI
NY1000207694Medicaid
NY2599923OtherGHI
NY442011157AMedicare PIN