MEDICARE: DR. YOGESH H 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	207RC0000X	Cardiovascular Disease Physician	ME61678	FL
2	207RC0000X	Cardiovascular Disease Physician	25MA04049300	NJ
3	207RC0000X	Cardiovascular Disease Physician	0101042153	VA

General Provider Information

NPI Number	:	1639117997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YOGESH H SHAH M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	07/08/2007

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