Provider Demographics
NPI:1871489369
Name:SHAH, PRACHI NITINBHAI (PT)
Entity type:Individual
Prefix:
First Name:PRACHI
Middle Name:NITINBHAI
Last Name:SHAH
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5205 VAN LOON ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-4258
Mailing Address - Country:US
Mailing Address - Phone:347-220-8195
Mailing Address - Fax:866-202-3177
Practice Address - Street 1:5205 VAN LOON ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4258
Practice Address - Country:US
Practice Address - Phone:347-220-8195
Practice Address - Fax:866-202-3177
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054307225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty