Provider Demographics
NPI:1720675903
Name:SHAH, PRIYA SAHIL
Entity type:Individual
Prefix:DR
First Name:PRIYA
Middle Name:SAHIL
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PRIYA
Other - Middle Name:
Other - Last Name:JAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66 WESTERVELT PL
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055-4627
Mailing Address - Country:US
Mailing Address - Phone:862-520-9064
Mailing Address - Fax:
Practice Address - Street 1:2720 SURF AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-1913
Practice Address - Country:US
Practice Address - Phone:862-520-9064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-22
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY038394-01225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist