Provider Demographics
NPI:1144474511
Name:SHAH, MELISSA D (MD)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:D
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:391 MYRTLE AVE STE 5
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12208-3797
Mailing Address - Country:US
Mailing Address - Phone:518-262-5640
Mailing Address - Fax:518-262-9413
Practice Address - Street 1:117 MARYS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-5849
Practice Address - Country:US
Practice Address - Phone:845-338-1992
Practice Address - Fax:845-338-1614
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2022-07-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY60 2656482086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03516823Medicaid
NY03516823Medicaid