Provider Demographics
NPI:1124612197
Name:SHAH, KANKSHINEE PIYUSHKUMAR
Entity type:Individual
Prefix:
First Name:KANKSHINEE
Middle Name:PIYUSHKUMAR
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 1:3508 95TH ST APT 2C
Mailing Address - Street 2:
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-6040
Mailing Address - Country:US
Mailing Address - Phone:845-326-6272
Mailing Address - Fax:
Practice Address - Street 1:3508 95TH ST APT 2C
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-6040
Practice Address - Country:US
Practice Address - Phone:845-326-6272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-21
Last Update Date:2021-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program