1326012410 NPI number — DR. CANDICE E SHAH MD

Table of content: DR. CANDICE E SHAH MD (NPI 1326012410)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326012410 NPI number — DR. CANDICE E SHAH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHAH
Provider First Name:
CANDICE
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PANARELLO
Provider Other First Name:
CANDICE
Provider Other Middle Name:
E
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326012410
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/25/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1673 S STATE ST
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
DOVER
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19901-5148
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-724-5125
Provider Business Mailing Address Fax Number:
302-380-4778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1673 S STATE ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOVER
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19901-5148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-724-5125
Provider Business Practice Location Address Fax Number:
302-380-4778
Provider Enumeration Date:
02/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  C1-0008211 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0042790 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".




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