Healthcare Provider Details

I. General information

NPI: 1144803016
Provider Name (Legal Business Name): YASH SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2696
US

IV. Provider business mailing address

2 HAWTHORNE PL APT 6G
BOSTON MA
02114-2307
US

V. Phone/Fax

Practice location:
  • Phone: 617-643-2652
  • Fax: 617-724-6981
Mailing address:
  • Phone: 609-955-0945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1026230
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: