Provider Demographics
NPI:1215277405
Name:SHAH, SHWETA (DPT)
Entity type:Individual
Prefix:MS
First Name:SHWETA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-2958
Mailing Address - Country:US
Mailing Address - Phone:631-482-3223
Mailing Address - Fax:631-482-3239
Practice Address - Street 1:152 E MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-2958
Practice Address - Country:US
Practice Address - Phone:631-482-3223
Practice Address - Fax:631-482-3239
Is Sole Proprietor?:No
Enumeration Date:2013-02-25
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY036015225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist