Healthcare Provider Details

I. General information

NPI: 1245261650
Provider Name (Legal Business Name): SANJAY GUNVANTLAL SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 04/18/2024
Certification Date: 04/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

713 VOLVO PKWY STE 200
CHESAPEAKE VA
23320-1614
US

IV. Provider business mailing address

713 VOLVO PKWY STE 200
CHESAPEAKE VA
23320-1614
US

V. Phone/Fax

Practice location:
  • Phone: 757-282-4150
  • Fax:
Mailing address:
  • Phone: 757-282-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number0101052810
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: