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1598007676

NPI Code Detail

MEDICARE: AVNI A SHAH MD

MEDICARE: AVNI A 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	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	A163015	CA
2	207W00000X	Ophthalmology Physician	A163015	CA
3	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician	269995	MA
4	207W00000X	Ophthalmology Physician	269995	MA

General Provider Information

NPI Number	:	1598007676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVNI A SHAH MD

Provider Business Mailing Address
First Line	:	3035 CLEVELAND AVE STE 100
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2122
Country	:	US
Telephone Number	:	707-546-9800
Fax Number	:

Provider Business Practice Location Address
First Line	:	3035 CLEVELAND AVE STE 100
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95403-2122
Country	:	US
Telephone Number	:	708-623-8200
Fax Number	:

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

Provider Enumeration Date	:	03/26/2013
Last Update Date	:	07/21/2025

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Directions to “ AVNI A SHAH MD” Practice Location

Language	Start Address	Practice Location

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