Provider Demographics
NPI:1669174041
Name:SHAH, CHAITALI
Entity type:Individual
Prefix:
First Name:CHAITALI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51JFK PARKWAY
Mailing Address - Street 2:1ST FLOOR WEST
Mailing Address - City:SHORT HILLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07078
Mailing Address - Country:US
Mailing Address - Phone:917-582-6622
Mailing Address - Fax:888-974-2142
Practice Address - Street 1:51 JFK PKWY FL 1
Practice Address - Street 2:
Practice Address - City:SHORT HILLS
Practice Address - State:NJ
Practice Address - Zip Code:07078-2713
Practice Address - Country:US
Practice Address - Phone:917-582-6622
Practice Address - Fax:888-974-2142
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ01454800363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health