MEDICARE: DR. SAYANA R 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	390200000X	Student in an Organized Health Care Education/Training Program
2	2085R0001X	Radiation Oncology Physician	A119100	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01090150	OTHER	CA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7696936	OTHER	CA	CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	P01090150	OTHER	CA	RAILROAD MCR
5	9893903	OTHER	CA	AETNA
6	00A119100Z63	OTHER	CA	CALOPTIMA

General Provider Information

NPI Number	:	1972793917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAYANA R SHAH M.D.

Provider Business Mailing Address
First Line	:	1043 ELM AVE STE 110
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3244
Country	:	US
Telephone Number	:	562-491-9890
Fax Number	:	562-491-9091

Provider Business Practice Location Address
First Line	:	1043 ELM AVE STE 110
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3244
Country	:	US
Telephone Number	:	562-491-9890
Fax Number	:	562-491-9091

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

Provider Enumeration Date	:	07/26/2007
Last Update Date	:	08/14/2024

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