Provider Demographics
NPI:1366878555
Name:SHAH, DEVINA (DMD)
Entity type:Individual
Prefix:DR
First Name:DEVINA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 MAXWELL LN
Mailing Address - Street 2:APARTMENT #707
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-6823
Mailing Address - Country:US
Mailing Address - Phone:908-208-6910
Mailing Address - Fax:
Practice Address - Street 1:412 PLEASANT VALLEY WAY
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2988
Practice Address - Country:US
Practice Address - Phone:973-731-2468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18560661223P0221X
NJ22DI026348001223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry