Provider Demographics
NPI:1598321267
Name:SHAH, KHUSHBU (MD)
Entity type:Individual
Prefix:
First Name:KHUSHBU
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MIDDLESEX TPKE STE 306B
Mailing Address - Street 2:
Mailing Address - City:ISELIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08830-2033
Mailing Address - Country:US
Mailing Address - Phone:732-305-8980
Mailing Address - Fax:732-398-5466
Practice Address - Street 1:200 MIDDLESEX TPKE STE 306B
Practice Address - Street 2:
Practice Address - City:ISELIN
Practice Address - State:NJ
Practice Address - Zip Code:08830-2033
Practice Address - Country:US
Practice Address - Phone:732-305-8980
Practice Address - Fax:732-398-5466
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA115511002084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry