Provider Demographics
NPI:1982130100
Name:SHAH, KRINA
Entity Type:Individual
Prefix:
First Name:KRINA
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 1:435 SOUTH ST STE 250
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6477
Mailing Address - Country:US
Mailing Address - Phone:973-971-5227
Mailing Address - Fax:
Practice Address - Street 1:435 SOUTH ST STE 250
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6477
Practice Address - Country:US
Practice Address - Phone:973-971-5227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-09
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00726600363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics