Healthcare Provider Details

I. General information

NPI: 1982018172
Provider Name (Legal Business Name): BINOY SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2014
Last Update Date: 06/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1222 S ORANGE AVE 5TH FLOOR MP 43
ORLANDO FL
32806-1215
US

IV. Provider business mailing address

1222 S ORANGE AVE 5TH FLOOR MP 43
ORLANDO FL
32806-1215
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-1764
  • Fax: 321-843-6992
Mailing address:
  • Phone: 321-841-1764
  • Fax: 321-843-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTRN20421
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: