Provider Demographics
NPI:1265306336
Name:SHAH, SHIVANI NITIN
Entity type:Individual
Prefix:
First Name:SHIVANI
Middle Name:NITIN
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 1:23578 N VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:LAKE ZURICH
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8705
Mailing Address - Country:US
Mailing Address - Phone:224-595-1829
Mailing Address - Fax:
Practice Address - Street 1:23578 N VALLEY RD
Practice Address - Street 2:
Practice Address - City:LAKE ZURICH
Practice Address - State:IL
Practice Address - Zip Code:60047-8705
Practice Address - Country:US
Practice Address - Phone:224-595-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program