Provider Demographics
NPI:1023058328
Name:SHAH, NIMISH M (DNP, CNS-BC)
Entity type:Individual
Prefix:DR
First Name:NIMISH
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:DNP, CNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 WORCESTER RD STE 203
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-5410
Mailing Address - Country:US
Mailing Address - Phone:508-834-3183
Mailing Address - Fax:508-834-3183
Practice Address - Street 1:1881 WORCESTER RD STE 203
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-5410
Practice Address - Country:US
Practice Address - Phone:508-834-3183
Practice Address - Fax:508-834-3183
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA230874363LP0808X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAQ63049Medicare UPIN
MASH-NS0779Medicare ID - Type Unspecified