Healthcare Provider Details

I. General information

NPI: 1417123605
Provider Name (Legal Business Name): SNEHAL SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2733
US

IV. Provider business mailing address

330 N CLYDE MORRIS BLVD
DAYTONA BEACH FL
32114-2733
US

V. Phone/Fax

Practice location:
  • Phone: 386-676-7175
  • Fax: 386-676-7134
Mailing address:
  • Phone: 386-676-7175
  • Fax: 386-676-7134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number75670
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number25MA09284700
License Number StateNJ
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME155622
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: