Individual
DR. MAHENDRA G. SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1866 WADING RIVER MANOR ROAD, WADING RIVER, NY 11792
(631) 929-8787
(631) 929-0350
Mailing address
P.O. BOX 625, WADING RIVER, NY 11792
(631) 929-8787
(631) 929-0350
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
136332
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00558567
—
NY
01
—
15A681
PTAN
NY
Enumeration date
10/02/2006
Last updated
07/21/2011
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