Provider Demographics
NPI:1285694778
Name:SHAH, SANJAY N (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MASSENA
Mailing Address - State:NY
Mailing Address - Zip Code:13662-1056
Mailing Address - Country:US
Mailing Address - Phone:315-769-4200
Mailing Address - Fax:315-769-4353
Practice Address - Street 1:181 MAPLE ST
Practice Address - Street 2:
Practice Address - City:MASSENA
Practice Address - State:NY
Practice Address - Zip Code:13662-1012
Practice Address - Country:US
Practice Address - Phone:315-769-4656
Practice Address - Fax:315-769-4671
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2015-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY167327208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01368721Medicaid
F19197Medicare UPIN
NYJ400150846Medicare PIN