Provider Demographics
NPI:1255375754
Name:SHAH, BELA SANJAY (MD)
Entity type:Individual
Prefix:DR
First Name:BELA
Middle Name:SANJAY
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BELA
Other - Middle Name:ANIRUDDHA
Other - Last Name:MEHTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:123 MILLSTONE DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-1738
Mailing Address - Country:US
Mailing Address - Phone:248-971-3450
Mailing Address - Fax:
Practice Address - Street 1:2925 LIVERNOIS RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083
Practice Address - Country:US
Practice Address - Phone:248-680-2060
Practice Address - Fax:248-680-2099
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010555792084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIF76194Medicare UPIN
MIM11770009Medicare ID - Type Unspecified