MEDICARE: MR. SANJAY SHAH PT

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	225100000X	Physical Therapist	8487	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	078M2	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1851450886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SANJAY SHAH PT

Provider Business Mailing Address
First Line	:	112 ANNANDALE DR
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27511-6502
Country	:	US
Telephone Number	:	919-851-1164
Fax Number	:	919-851-1196

Provider Business Practice Location Address
First Line	:	519 KEISLER DR. STE# 204
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27518-7098
Country	:	US
Telephone Number	:	919-851-1164
Fax Number	:	919-851-1196

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

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/06/2024

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Directions to “ MR. SANJAY SHAH PT” Practice Location

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