Provider Demographics
NPI:1336281823
Name:SHAH, NEEL (MD)
Entity type:Individual
Prefix:DR
First Name:NEEL
Middle Name:
Last Name:SHAH
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Gender:M
Credentials:MD
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Mailing Address - Street 1:26908 INDEPENDENCE WAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVANS MILLS
Mailing Address - State:NY
Mailing Address - Zip Code:13637-3302
Mailing Address - Country:US
Mailing Address - Phone:315-629-4525
Mailing Address - Fax:315-629-4086
Practice Address - Street 1:11050 MT. BELVEDERE BLVD
Practice Address - Street 2:GOLD 1410
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602
Practice Address - Country:US
Practice Address - Phone:315-772-2235
Practice Address - Fax:153-971-0011
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2024-07-25
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Provider Licenses
StateLicense IDTaxonomies
OK24693207Q00000X
NY268065207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine