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Contact Information

MAHENDRA G SHAH, MD
1866 WADING RIVER MANOR ROAD
WADING RIVER, NY11792
 Phone: 631-929-8787
 Fax: 631-929-0350
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
Indicates primary specialty

NPI Profile & details for MAHENDRA G SHAH · (Male)

NPI Number 1215020011
Status Active
Credentials MD
Entity Individual
Enumeration date 10/02/2006
Last updated 07/21/2011 - About 15 years ago
Sole proprietor 1 Yes
Identifiers
  • NY License # 136332
  • NY Medicaid 00558567
  • NY Other 15A681 PTAN
Hospital affiliation(s)
  • JOHN T MATHER MEMORIAL HOSPITAL OF PORT JEFFERSON - (Acute Care)
    75 NORTH COUNTRY ROAD
    PORT JEFFERSON, NY 11777
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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