Healthcare Provider Details

I. General information

NPI: 1558788935
Provider Name (Legal Business Name): TRISHA SHAH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TRISHA KADAKIA M.D.

II. Dates (important events)

Enumeration Date: 03/24/2014
Last Update Date: 08/21/2024
Certification Date: 08/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4425 PONCE DE LEON BLVD STE 110
CORAL GABLES FL
33146-1842
US

IV. Provider business mailing address

4425 PONCE DE LEON BLVD STE 110
CORAL GABLES FL
33146-1842
US

V. Phone/Fax

Practice location:
  • Phone: 305-446-4673
  • Fax:
Mailing address:
  • Phone: 305-446-4673
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License NumberME148605
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: