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General NPI Number Information
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NPI Number | 1003040981
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Entity Type | Individual
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Provider Name | AKSHAY VIJAY SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2009
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Last Update Date | 09/28/2011
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Provider Practice Location Address
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Address Line | 14155 N 83RD AVE SUITE 122
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City | PEORIA
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State | AZ
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Zip | 85381-5639
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Country | US
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Telephone | 623-773-1161
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Fax | 623-773-1181
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Provider Business Mailing Address
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Address Line | 14155 N 83RD AVE SUITE 122
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City | PEORIA
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State | AZ
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Zip | 85381-5639
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Country | US
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Telephone | 623-773-1161
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Fax | 623-773-1181
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 251288
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 42590
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License Number State | AZ
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Legacy Identifiers
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Identifier #1
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Identifier Code | 509244
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Identifier Type | MEDICAID
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Identifier State | AZ
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 509244
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Identifier Type | MEDICAID
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Identifier State | AZ
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Identifier Issuer |
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