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NPI Code Detail

MEDICARE: DR. ATUL MUKUTBHAI SHAH MD

MEDICARE: DR. ATUL MUKUTBHAI SHAH MD
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
1174400000XSpecialistME0048902FL
22084P0800XPsychiatry PhysicianME48902FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1962471169
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ATUL MUKUTBHAI SHAH MD
Provider Business Mailing Address
First Line : 6310 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-2708
Country : US
Telephone Number : 904-725-6463
Fax Number : 904-724-5006
Provider Business Practice Location Address
First Line : 6310 BEACH BLVD
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-2708
Country : US
Telephone Number : 904-725-6463
Fax Number : 904-724-5006
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/17/2006
Last Update Date : 02/24/2020

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