Provider Demographics
NPI:1053136853
Name:SHAH, VANDANA TEJAS (AGPCNP)
Entity type:Individual
Prefix:MRS
First Name:VANDANA
Middle Name:TEJAS
Last Name:SHAH
Suffix:
Gender:
Credentials:AGPCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 CASEY LN
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-3968
Mailing Address - Country:US
Mailing Address - Phone:732-372-1449
Mailing Address - Fax:
Practice Address - Street 1:112 CASEY LN
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-3968
Practice Address - Country:US
Practice Address - Phone:732-372-1449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030690363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care