Healthcare Provider Details

I. General information

NPI: 1962458190
Provider Name (Legal Business Name): NILESH SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 08/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 OLIVE ST STE 201
AKRON OH
44310-3169
US

IV. Provider business mailing address

20 OLIVE ST STE 201
AKRON OH
44310-3169
US

V. Phone/Fax

Practice location:
  • Phone: 330-379-5051
  • Fax: 330-379-5074
Mailing address:
  • Phone: 330-379-5051
  • Fax: 330-379-5074

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number35-076963
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: