Provider Demographics
NPI:1922023001
Name:SHAH, SUBHADRA SUNDARAM (MD)
Entity Type:Individual
Prefix:DR
First Name:SUBHADRA
Middle Name:SUNDARAM
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 1:199 BALDWIN RD
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-2043
Mailing Address - Country:US
Mailing Address - Phone:973-335-2560
Mailing Address - Fax:973-335-9421
Practice Address - Street 1:199 BALDWIN RD
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-2043
Practice Address - Country:US
Practice Address - Phone:973-335-2560
Practice Address - Fax:973-335-9421
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA07539600207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
2066980Medicare ID - Type Unspecified
NJH80607Medicare UPIN