Individual
MUKESH SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1656 CHAMPLIN AVE, UTICA, NY 13502-4830
(315) 724-4017
Mailing address
1656 CHAMPLIN AVE, UTICA, NY 13502-4830
(315) 724-4017
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
153083
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00796901
—
NY
01
—
153083
NY STATE LICESNSE
NY
01
—
165131
MVP HEALTHCARE
NY
01
—
33DO942942
CLIA LICENSE
NY
Enumeration date
12/25/2006
Last updated
03/07/2023
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