Provider Demographics
NPI:1295884666
Name:SHAH, SWARNA B (MD)
Entity type:Individual
Prefix:DR
First Name:SWARNA
Middle Name:B
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 AVENUE Y
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-6126
Mailing Address - Country:US
Mailing Address - Phone:516-647-7422
Mailing Address - Fax:718-891-8210
Practice Address - Street 1:739 AVENUE Y
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-6126
Practice Address - Country:US
Practice Address - Phone:516-647-7422
Practice Address - Fax:718-891-8210
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY154777208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYSS015D5210Medicare PIN