Provider Demographics
NPI:1861660987
Name:SHELAT, AMIT MAHESH (DO)
Entity Type:Individual
Prefix:DR
First Name:AMIT
Middle Name:MAHESH
Last Name:SHELAT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 HOLIDAY POND RD
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:NY
Mailing Address - Zip Code:11753-1154
Mailing Address - Country:US
Mailing Address - Phone:516-822-3917
Mailing Address - Fax:516-932-0241
Practice Address - Street 1:21 HOLIDAY POND RD
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:NY
Practice Address - Zip Code:11753-1154
Practice Address - Country:US
Practice Address - Phone:516-822-3917
Practice Address - Fax:516-932-0241
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2387942084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03052348Medicaid