Provider Demographics
NPI:1720305568
Name:MEHTA, SHILPI BHADRA (OD)
Entity Type:Individual
Prefix:DR
First Name:SHILPI
Middle Name:BHADRA
Last Name:MEHTA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SHILPI
Other - Middle Name:MISTY
Other - Last Name:BHADRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1925 KEITH RD UNIT 623
Mailing Address - Street 2:
Mailing Address - City:ABINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19001
Mailing Address - Country:US
Mailing Address - Phone:617-969-1907
Mailing Address - Fax:
Practice Address - Street 1:8360 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027
Practice Address - Country:US
Practice Address - Phone:215-780-1400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-03
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003514152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist