Healthcare Provider Details

I. General information

NPI: 1518960673
Provider Name (Legal Business Name): MINESH SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13908 US HIGHWAY 29
CHATHAM VA
24531-3669
US

IV. Provider business mailing address

13908 US HIGHWAY 29
CHATHAM VA
24531-3669
US

V. Phone/Fax

Practice location:
  • Phone: 434-432-0216
  • Fax: 434-432-3425
Mailing address:
  • Phone: 434-432-0216
  • Fax: 434-432-3425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101236035
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: