Provider Demographics
NPI:1851572622
Name:SHAH, SHALINI BHARAT (MD)
Entity Type:Individual
Prefix:
First Name:SHALINI
Middle Name:BHARAT
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1342 SOUTH GOVERNORS AVENUE
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904
Mailing Address - Country:US
Mailing Address - Phone:302-734-2500
Mailing Address - Fax:302-734-7758
Practice Address - Street 1:1342 S GOVERNORS AVE
Practice Address - Street 2:SUITE E
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4804
Practice Address - Country:US
Practice Address - Phone:302-734-2500
Practice Address - Fax:302-734-7758
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-20
Last Update Date:2017-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC1-0009869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE043805OtherMEDICARE