Provider Demographics
NPI:1922330166
Name:SHAH, AXAY RAMESH
Entity Type:Individual
Prefix:
First Name:AXAY
Middle Name:RAMESH
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 47TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-5225
Mailing Address - Country:US
Mailing Address - Phone:718-213-4787
Mailing Address - Fax:
Practice Address - Street 1:4555 47TH ST FL 2
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-5225
Practice Address - Country:US
Practice Address - Phone:718-213-4787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-11
Last Update Date:2010-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053541-1183500000X
NJ28RI03301600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist