MEDICARE: ASHOK 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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1720259930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ASHOK SHAH MD PA

Provider Business Mailing Address
First Line	:	3808 S HOPKINS AVE
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-5753
Country	:	US
Telephone Number	:	321-268-2005
Fax Number	:	321-264-2235

Provider Business Practice Location Address
First Line	:	3808 S HOPKINS AVE
Second Line	:
City	:	TITUSVILLE
State	:	FL
Zip	:	32780-5753
Country	:	US
Telephone Number	:	321-268-2005
Fax Number	:	321-264-2235

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ASHOK C SHAH
Credential	:	MD
Telephone Number	:	321-268-2005

Provider Enumeration Date	:	03/14/2008
Last Update Date	:	04/30/2008

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