Healthcare Provider Details

I. General information

NPI: 1336836253
Provider Name (Legal Business Name): DEVIN J SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2023
Last Update Date: 07/08/2024
Certification Date: 06/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

VCUHS DEPT OF GENERAL SURGERY RESIDENCY 1001 EAST LEIGH STREET
RICHMOND VA
23298-0257
US

IV. Provider business mailing address

PO BOX 980257
RICHMOND VA
23298-0257
US

V. Phone/Fax

Practice location:
  • Phone: 804-628-7497
  • Fax: 804-827-1016
Mailing address:
  • Phone: 804-828-9783
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number0116037913
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: