Provider Demographics
NPI:1427522804
Name:SHAH, VARSHA C
Entity type:Individual
Prefix:
First Name:VARSHA
Middle Name:C
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 1:196 NASSAU BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11040-4419
Mailing Address - Country:US
Mailing Address - Phone:516-294-9755
Mailing Address - Fax:
Practice Address - Street 1:196 NASSAU BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY PARK
Practice Address - State:NY
Practice Address - Zip Code:11040-4419
Practice Address - Country:US
Practice Address - Phone:516-294-9755
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30319333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy