MEDICARE: DR. M. MOHSIN SHAH M.D.

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084V0102X	Vascular Neurology Physician	103463	MN
2	207T00000X	Neurological Surgery Physician	43336	KY
3	207T00000X	Neurological Surgery Physician	MD60010649	WA
4	2084V0102X	Vascular Neurology Physician	A066315	CA
5	207T00000X	Neurological Surgery Physician	A066315	CA
6	207T00000X	Neurological Surgery Physician	ME110039	FL

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00A663150	OTHER	CA	BLUE SHIELD

NPI Number	:	1811970726
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. M. MOHSIN SHAH M.D.

Provider Business Mailing Address
First Line	:	200 3RD AVE W STE 200
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-8633
Country	:	US
Telephone Number	:	941-794-3118
Fax Number	:	941-782-2017

Provider Business Practice Location Address
First Line	:	200 3RD AVE W STE 200
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-8633
Country	:	US
Telephone Number	:	941-794-3118
Fax Number	:	941-782-2017

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	04/06/2026

200 3RD AVE W STE 200
BRADENTON, FL
34205-8633

Practice Phone: 941-794-3118
Practice Fax: 941-782-2017