Provider Demographics
NPI:1720469950
Name:SHAH, SHEFALI (MD)
Entity Type:Individual
Prefix:
First Name:SHEFALI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 ROUTE 36 STE 230
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1306
Mailing Address - Country:US
Mailing Address - Phone:732-222-3805
Mailing Address - Fax:215-762-7765
Practice Address - Street 1:1912 STATE ROUTE 35 STE 201
Practice Address - Street 2:
Practice Address - City:OAKHURST
Practice Address - State:NJ
Practice Address - Zip Code:07755-2768
Practice Address - Country:US
Practice Address - Phone:732-389-5004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJS31427047559882207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine