MEDICARE: DR. HEMANT N SHAH M.D.

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	208VP0014X	Interventional Pain Medicine Physician	ME95262	FL

General Provider Information

NPI Number	:	1154326973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEMANT N SHAH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 600290
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32260-0290
Country	:	US
Telephone Number	:	904-268-8200
Fax Number	:	904-268-8298

Provider Business Practice Location Address
First Line	:	9421 WAYPOINT PL
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32257-9229
Country	:	US
Telephone Number	:	904-268-8200
Fax Number	:	904-268-8298

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

Provider Enumeration Date	:	06/17/2005
Last Update Date	:	12/21/2010

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