Healthcare Provider Details

I. General information

NPI: 1538712526
Provider Name (Legal Business Name): DEVKI SHAILESH SHAH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEVKI SHAILESH PATEL PA-C

II. Dates (important events)

Enumeration Date: 07/19/2019
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19045 E VALLEY VIEW PKWY STE G
INDEPENDENCE MO
64055-9935
US

IV. Provider business mailing address

963 2ND AVE NW
CARMEL IN
46032-1384
US

V. Phone/Fax

Practice location:
  • Phone: 816-398-7171
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10003142A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2025011380
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: