Healthcare Provider Details

I. General information

NPI: 1053660886
Provider Name (Legal Business Name): KAIRAV RAMESHCHANDRA SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2012
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 MCHENRY AVE STE 445
MODESTO CA
95350-4573
US

IV. Provider business mailing address

1524 MCHENRY AVE STE 445
MODESTO CA
95350-4573
US

V. Phone/Fax

Practice location:
  • Phone: 209-571-1693
  • Fax:
Mailing address:
  • Phone: 209-571-1693
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number268942
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME134702
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA142095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: