MEDICARE: SANJAY JAYANTILAL 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	207R00000X	Internal Medicine Physician	MD23307	AZ
2	208M00000X	Hospitalist Physician	MD23307	AZ

General Provider Information

NPI Number	:	1952315988
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANJAY JAYANTILAL SHAH M.D.

Provider Business Mailing Address
First Line	:	5523 W LARIAT LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-1231
Country	:	US
Telephone Number	:	602-842-7555
Fax Number	:	602-743-0183

Provider Business Practice Location Address
First Line	:	5523 W LARIAT LN
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85083-1231
Country	:	US
Telephone Number	:	602-842-7555
Fax Number	:	602-743-0183

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	10/22/2019

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