Healthcare Provider Details

I. General information

NPI: 1760895015
Provider Name (Legal Business Name): SHIVAN SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2014
Last Update Date: 02/27/2023
Certification Date: 02/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 BIRD RD
MIAMI FL
33175-3530
US

IV. Provider business mailing address

11750 BIRD RD
MIAMI FL
33175-3530
US

V. Phone/Fax

Practice location:
  • Phone: 305-480-6663
  • Fax:
Mailing address:
  • Phone: 305-480-6663
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberME157277
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: