Provider Demographics
NPI:1922264795
Name:SHAH, VRINDA B
Entity Type:Individual
Prefix:DR
First Name:VRINDA
Middle Name:B
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W MAIN ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-2521
Mailing Address - Country:US
Mailing Address - Phone:732-866-9300
Mailing Address - Fax:732-866-9747
Practice Address - Street 1:1000 W MAIN ST
Practice Address - Street 2:SUITE 5
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2521
Practice Address - Country:US
Practice Address - Phone:732-866-9300
Practice Address - Fax:732-866-9747
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA067025208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics