Organization
PROSPERITY MEDICAL, PLLC
Active
Parent organization
PROSPERITY MEDICAL, PLLC
Other names
Stonegate Dermatology and Medical Spa
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROSPERITY MEDICAL, PLLC
Authorized official
DR. RIDDHI JAY SHAH DO (PHYSICIAN)
(516) 263-0167
Entity
Organization
Contact information
Practice address
3901 STONEGATE PARK STE 300, SAINT JOSEPH, MI 49085-9136
(269) 408-4265
(269) 556-6020
Mailing address
PO BOX 546, STEVENSVILLE, MI 49127-0546
(516) 263-0167
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Enumeration date
12/22/2023
Last updated
12/22/2023
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