Healthcare Provider Details

I. General information

NPI: 1679069538
Provider Name (Legal Business Name): RONAK RAKESH SHAH DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 W SUNRISE BLVD BLDG C
PLANTATION FL
33322-5426
US

IV. Provider business mailing address

7351 W OAKLAND PARK BLVD STE 106
TAMARAC FL
33319-7107
US

V. Phone/Fax

Practice location:
  • Phone: 954-370-8585
  • Fax: 954-370-1585
Mailing address:
  • Phone:
  • Fax: 954-578-2783

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number011203
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberOS19424
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: