MEDICARE: YOGESH H SHAH MD PA

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	261QM2500X	Medical Specialty Clinic/Center	ME61678	FL

General Provider Information

NPI Number	:	1225376700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YOGESH H SHAH MD PA

Provider Business Mailing Address
First Line	:	501 LIVE OAK ST
Second Line	:	SUITE A
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7312
Country	:	US
Telephone Number	:	386-426-2060
Fax Number	:	386-426-6533

Provider Business Practice Location Address
First Line	:	501 LIVE OAK ST
Second Line	:	SUITE A
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7312
Country	:	US
Telephone Number	:	386-426-2060
Fax Number	:	386-426-6533

Authorized Official
Title or Position	:	CARDIOLOGIST/OWNER
Name	:	DR. YOGESH H SHAH
Credential	:	M.D.
Telephone Number	:	386-426-2060

Provider Enumeration Date	:	01/17/2013
Last Update Date	:	01/17/2013

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