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General NPI Number Information
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NPI Number | 1083098206
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Entity Type | Individual
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Provider Name | MONA NANDKISHOR SHAH D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 02/28/2024
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Provider Practice Location Address
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Address Line | 1015 US HIGHWAY 19
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City | HOLIDAY
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State | FL
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Zip | 34691-5636
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Country | US
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Telephone | 727-935-1144
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Fax |
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Provider Business Mailing Address
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Address Line | 12858 BERRYPICK TRL
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City | ODESSA
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State | FL
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Zip | 33556-3782
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Country | US
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Telephone | 727-421-5145
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Fax |
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | UO4472
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License Number State | FL
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