Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 25MB09976600 | NJ |
NPI | 1003203118 |
---|---|
Provider Name | Dr. Sweta Shah |
First Address | Toms River, NJ 08755-5037 |
Second Address | Toms River, NJ 08755-5037 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2015 |
Last Update Date | 08/04/2019 |