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General NPI Number Information
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NPI Number | 1871534925
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Entity Type | Individual
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Provider Name | BOBBY AJAY SHAH M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/09/2006
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Last Update Date | 01/16/2023
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Provider Practice Location Address
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Address Line | 3275 SW DARWIN BLVD
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City | PORT ST LUCIE
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State | FL
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Zip | 34953-3317
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Country | US
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Telephone | 800-437-2672
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Fax |
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Provider Business Mailing Address
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Address Line | 825 E LINCOLNWAY
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City | VALPARAISO
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State | IN
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Zip | 46383-5803
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Country | US
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Telephone | 219-464-4891
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Fax | 219-464-1873
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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 | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 01056041A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 01056041A
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License Number State | IN
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