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General NPI Number Information
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NPI Number | 1194177857
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Entity Type | Organization
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Legal Business Name | NILAM D SHAH PA
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Dates
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Enumeration Date | 07/06/2016
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 5778 5TH AVE N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-7104
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Country | US
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Telephone | 727-388-2625
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Fax | 727-828-9233
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Provider Business Mailing Address
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Address Line | 5778 5TH AVE N
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City | SAINT PETERSBURG
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State | FL
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Zip | 33710-7104
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Country | US
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Telephone | 727-388-2625
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Fax | 727-828-9233
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NILAMBEN D SHAH
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Credential | MD
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Telephone | 727-417-0233
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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