Provider Demographics
NPI:1740078963
Name:SHAH, BHARVI S
Entity type:Individual
Prefix:MS
First Name:BHARVI
Middle Name:S
Last Name:SHAH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8625 DONGAN AVE APT 4A
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3852
Mailing Address - Country:US
Mailing Address - Phone:917-431-6207
Mailing Address - Fax:
Practice Address - Street 1:1129 NORTHERN BLVD STE 40
Practice Address - Street 2:
Practice Address - City:MANHASSET
Practice Address - State:NY
Practice Address - Zip Code:11030-3045
Practice Address - Country:US
Practice Address - Phone:718-395-4522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-28
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician