Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | SC007033 | PA |
N | 222Z00000X | Podiatrist | SC007033 | PA |
N | 213EP1101X | Primary Podiatric Medicine | SC007033 | PA |
N | 111NR0200X | Radiology | SC007033 | PA |
N | 213ER0200X | Radiology | SC007033 | PA |
N | 2081S0010X | Sports Medicine | SC007033 | PA |
N | 213ES0000X | Sports Medicine | SC007033 | PA |
Y | 213ES0103X | Foot & Ankle Surgery | SC007033 | PA |
N | 213ES0131X | Foot Surgery | SC007033 | PA |
NPI | 1164985883 |
---|---|
Provider Name | Deep N Shah |
First Address | Watervliet, NY 12189-1309 |
Second Address | Chester, PA 19013-3902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/04/2019 |
Last Update Date | 09/07/2019 |