MEDICARE: DR. NEERAV S SHAH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician	ME79386	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144212770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEERAV S SHAH MD

Provider Business Mailing Address
First Line	:	PO BOX 939
Second Line	:
City	:	LOXAHATCHEE
State	:	FL
Zip	:	33470-0939
Country	:	US
Telephone Number	:	561-793-6100
Fax Number	:	561-793-1974

Provider Business Practice Location Address
First Line	:	3347 STATE ROAD 7
Second Line	:	STE 203
City	:	WELLINGTON
State	:	FL
Zip	:	33449-8095
Country	:	US
Telephone Number	:	561-793-6100
Fax Number	:	561-793-1974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	04/05/2012

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