Provider Demographics
NPI:1912063793
Name:SHAH, SHEELPA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHEELPA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 STATE STREET
Mailing Address - Street 2:SUITE 1D
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666
Mailing Address - Country:US
Mailing Address - Phone:201-837-3000
Mailing Address - Fax:201-837-0997
Practice Address - Street 1:100 STATE STREET
Practice Address - Street 2:SUITE 1D
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666
Practice Address - Country:US
Practice Address - Phone:201-837-3000
Practice Address - Fax:201-837-0997
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJD120769122300000X
PADS030321L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist