MEDICARE: SENTINEL HEALTHCARE WA

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1225656614
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SENTINEL HEALTHCARE WA

Provider Business Mailing Address
First Line	:	PO BOX 13308
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85216-3308
Country	:	US
Telephone Number	:	480-335-1865
Fax Number	:	914-663-5152

Provider Business Practice Location Address
First Line	:	2220 76TH AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-2114
Country	:	US
Telephone Number	:	812-760-5313
Fax Number	:

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	NIRAV H. SHAH
Credential	:	MD
Telephone Number	:	812-760-5313

Provider Enumeration Date	:	07/11/2020
Last Update Date	:	09/06/2023

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