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General NPI Number Information
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NPI Number | 1104091933
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Entity Type | Individual
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Provider Name | ANJAN R SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2008
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Last Update Date | 01/27/2020
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Provider Practice Location Address
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Address Line | 560 S LAKEWOOD DR STE 101
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City | BRANDON
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State | FL
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Zip | 33511-5016
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Country | US
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Telephone | 813-978-9700
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Fax | 813-558-6434
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Provider Business Mailing Address
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Address Line | 13020 N TELECOM PKWY
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-0925
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Country | US
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Telephone | 813-978-9700
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Fax | 813-558-6186
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | ME100905
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License Number State | FL
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