Provider Demographics
NPI:1366886798
Name:SHAH, AGNYA (RD)
Entity type:Individual
Prefix:
First Name:AGNYA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4275
Mailing Address - Country:US
Mailing Address - Phone:908-685-3159
Mailing Address - Fax:
Practice Address - Street 1:47 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4275
Practice Address - Country:US
Practice Address - Phone:908-685-3159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-29
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ991904133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered