Provider Demographics
NPI:1396170684
Name:SHAH, BINA (RD)
Entity type:Individual
Prefix:
First Name:BINA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BINA
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2211 MOORPARK AVE STE 218
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2629
Mailing Address - Country:US
Mailing Address - Phone:409-998-2325
Mailing Address - Fax:408-998-2022
Practice Address - Street 1:2211 MOORPARK AVE STE 218
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-2629
Practice Address - Country:US
Practice Address - Phone:408-998-2325
Practice Address - Fax:408-998-2022
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA707104133VN1006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1006XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Metabolic