Basic Information
| Provider Information | |||||||||
| NPI: | 1720469950 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | SHEFALI | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 187 ROUTE 36 STE 230 | ||||||||
| Address2: | |||||||||
| City: | WEST LONG BRANCH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077641306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322223805 | ||||||||
| FaxNumber: | 2157627765 | ||||||||
| Practice Location | |||||||||
| Address1: | 1912 STATE ROUTE 35 STE 201 | ||||||||
| Address2: | |||||||||
| City: | OAKHURST | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077552768 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7323895004 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2015 | ||||||||
| LastUpdateDate: | 10/26/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/26/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | S31427047559882 | NJ | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.