Provider Demographics
NPI:1891899340
Name:SHAH, AMISHA (MS, CGC)
Entity Type:Individual
Prefix:MS
First Name:AMISHA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4828 202ND ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1035
Mailing Address - Country:US
Mailing Address - Phone:646-236-8272
Mailing Address - Fax:718-334-3590
Practice Address - Street 1:79-01 BROADWAY
Practice Address - Street 2:ROOM H1-106 GREEN
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373
Practice Address - Country:US
Practice Address - Phone:718-334-5199
Practice Address - Fax:718-334-3590
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2005263170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS