Provider Demographics
NPI:1407485402
Name:SHAH, NIKITA PARAG (DO)
Entity type:Individual
Prefix:
First Name:NIKITA
Middle Name:PARAG
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 BROOKLINE AVE, E/SHAPIRO BLDG
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215
Mailing Address - Country:US
Mailing Address - Phone:617-754-9600
Mailing Address - Fax:617-667-8665
Practice Address - Street 1:330 BROOKLINE AVE, E/SHAPIRO BLDG
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215
Practice Address - Country:US
Practice Address - Phone:617-754-9600
Practice Address - Fax:617-667-8665
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2024-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1018196207R00000X
CA20A21220207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine