Provider Demographics
NPI:1336259423
Name:SHAH, MAYUR J (RPH)
Entity Type:Individual
Prefix:MR
First Name:MAYUR
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CASEY LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2353
Mailing Address - Country:US
Mailing Address - Phone:631-928-2687
Mailing Address - Fax:631-732-0013
Practice Address - Street 1:249 MIDDLE COUNTRY RD
Practice Address - Street 2:
Practice Address - City:SELDEN
Practice Address - State:NY
Practice Address - Zip Code:11784-2516
Practice Address - Country:US
Practice Address - Phone:631-732-7373
Practice Address - Fax:631-732-0013
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist