Provider Demographics
NPI:1356521587
Name:SHAH, DEEPALI A (DO, MPH)
Entity type:Individual
Prefix:DR
First Name:DEEPALI
Middle Name:A
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO, MPH
Other - Prefix:DR
Other - First Name:DEEPALI
Other - Middle Name:C
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO, MPH
Mailing Address - Street 1:55 MADISON AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-7337
Mailing Address - Country:US
Mailing Address - Phone:973-993-9536
Mailing Address - Fax:
Practice Address - Street 1:1199 PLEASANT VALLEY WAY
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1424
Practice Address - Country:US
Practice Address - Phone:973-993-9536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-05
Last Update Date:2020-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB08762400208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL207R00000XOtherRESIDENT
NJ2MB08762400OtherNEW JERSEY DIVISION OF CONSUMER AFFAIRS