Provider Demographics
NPI:1265407050
Name:SHAH, SAPANA J (MD, MPH)
Entity type:Individual
Prefix:
First Name:SAPANA
Middle Name:J
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:462 1ST AVENUE
Mailing Address - Street 2:BELLEVUE AMBULATORY CARE PAVILION 2ND FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016
Mailing Address - Country:US
Mailing Address - Phone:212-562-1686
Mailing Address - Fax:
Practice Address - Street 1:462 1ST AVE
Practice Address - Street 2:BELLEVUE AMBULATORY CARE PAVILION 2ND FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-9196
Practice Address - Country:US
Practice Address - Phone:212-562-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY227049-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00665274Medicaid
NY00665274Medicaid
NYW92171Medicare ID - Type Unspecified