Healthcare Provider Details

I. General information

NPI: 1457715237
Provider Name (Legal Business Name): AMAR SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 08/13/2021
Certification Date: 08/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 17TH ST
MIAMI FL
33136-1119
US

IV. Provider business mailing address

1945 CEI DR
BLUE ASH OH
45242-5664
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-6837
  • Fax: 305-326-6306
Mailing address:
  • Phone: 513-984-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number35143118
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME144412
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: