Provider Demographics
NPI:1073731147
Name:SHAH, NEHAL
Entity type:Individual
Prefix:
First Name:NEHAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 FARMINGTON AVENUE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06030-2803
Mailing Address - Country:US
Mailing Address - Phone:860-679-2784
Mailing Address - Fax:860-679-3145
Practice Address - Street 1:263 FARMINGTON AVENUE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06030-2803
Practice Address - Country:US
Practice Address - Phone:860-679-2784
Practice Address - Fax:860-679-3145
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RILP004772085R0202X
CT0769342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000764901Medicare PIN