Provider Demographics
NPI:1801143326
Name:SHAH, NIKUNJBALA AMIT
Entity type:Individual
Prefix:MRS
First Name:NIKUNJBALA
Middle Name:AMIT
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:NIKI
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:20 HATIKVA WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2333
Mailing Address - Country:US
Mailing Address - Phone:978-319-3033
Mailing Address - Fax:
Practice Address - Street 1:20 HATIKVA WAY
Practice Address - Street 2:
Practice Address - City:NORTH CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2333
Practice Address - Country:US
Practice Address - Phone:978-319-3033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH87139124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist