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General NPI Number Information
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NPI Number | 1790095651
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Entity Type | Organization
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Legal Business Name | SHAILESH SHAH M.D.P.A.
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Dates
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Enumeration Date | 10/13/2010
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Last Update Date | 04/27/2013
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Provider Practice Location Address
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Address Line | 8250 LAKE SERENE DR
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City | ORLANDO
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State | FL
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Zip | 32836-5023
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Country | US
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Telephone | 407-370-0271
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Fax |
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Provider Business Mailing Address
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Address Line | 8250 LAKE SERENE DR
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City | ORLANDO
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State | FL
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Zip | 32836-5023
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Country | US
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Telephone | 407-370-0271
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SHAILESH SHAH
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Credential | M.D.
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Telephone | 407-370-0271
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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 | ME67094
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License Number State | FL
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