Provider Demographics
NPI:1174999668
Name:SHAH-MEHTA, PUJA (MS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:PUJA
Middle Name:
Last Name:SHAH-MEHTA
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 W 86TH ST
Mailing Address - Street 2:APT 2A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3428
Mailing Address - Country:US
Mailing Address - Phone:646-709-5797
Mailing Address - Fax:
Practice Address - Street 1:137 W 86TH ST
Practice Address - Street 2:APT 2A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3428
Practice Address - Country:US
Practice Address - Phone:646-709-5797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY14035223235Z00000X
NY021525235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist