Healthcare Provider Details

I. General information

NPI: 1336374545
Provider Name (Legal Business Name): PURVIN SHAH, DO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2009
Last Update Date: 01/28/2022
Certification Date: 01/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6017 PINE RIDGE RD. PMB #462
NAPLES FL
34119
US

IV. Provider business mailing address

6017 PINE RIDGE RD. PMB #462
NAPLES FL
34119
US

V. Phone/Fax

Practice location:
  • Phone: 904-435-7993
  • Fax:
Mailing address:
  • Phone: 904-435-7993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PURVIN SHAH
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 904-435-7993