Provider Demographics
NPI:1144960311
Name:SHAH, KANDRAP YASHVANT (PTA)
Entity type:Individual
Prefix:
First Name:KANDRAP
Middle Name:YASHVANT
Last Name:SHAH
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 ONTARIO AVE
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:NY
Mailing Address - Zip Code:11803-3534
Mailing Address - Country:US
Mailing Address - Phone:516-343-7577
Mailing Address - Fax:
Practice Address - Street 1:36 ONTARIO AVE
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-3534
Practice Address - Country:US
Practice Address - Phone:516-343-7577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-29
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008497225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy AssistantGroup - Single Specialty