Healthcare Provider Details

I. General information

NPI: 1811094204
Provider Name (Legal Business Name): KAMLESH M SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/14/2026
Certification Date: 04/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 BUDINGER AVE STE 206
SAINT CLOUD FL
34769-4123
US

IV. Provider business mailing address

1330 BUDINGER AVE STE 206
SAINT CLOUD FL
34769-4123
US

V. Phone/Fax

Practice location:
  • Phone: 407-891-2970
  • Fax: 407-891-2971
Mailing address:
  • Phone: 407-891-2970
  • Fax: 407-891-2971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number25MA08190600
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME176966
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: