Healthcare Provider Details

I. General information

NPI: 1316259864
Provider Name (Legal Business Name): NISHIT SHASHIKANT SHAH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2010
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40910 FREMONT BLVD STE 300
FREMONT CA
94538-4375
US

IV. Provider business mailing address

5504 MONTEREY HWY
SAN JOSE CA
95138-1529
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-8040
  • Fax: 510-770-8141
Mailing address:
  • Phone: 510-770-8040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA167291
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: