Provider Demographics
NPI:1851517247
Name:SHAH, SEJAL JAGDISH (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEJAL
Middle Name:JAGDISH
Last Name:SHAH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W 54TH ST
Mailing Address - Street 2:#10E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-5500
Mailing Address - Country:US
Mailing Address - Phone:917-686-2546
Mailing Address - Fax:
Practice Address - Street 1:225 W 35TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-1904
Practice Address - Country:US
Practice Address - Phone:212-564-8164
Practice Address - Fax:212-244-4522
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0497121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice