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General NPI Number Information
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NPI Number | 1891010476
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Entity Type | Individual
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Provider Name | NISHAN ANILKUMAR SHAH MD
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Gender | Male
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Dates
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Enumeration Date | 04/07/2010
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Last Update Date | 01/24/2025
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Provider Practice Location Address
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Address Line | 2810 MANATEE AVE E
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City | BRADENTON
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State | FL
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Zip | 34208-1828
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Country | US
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Telephone | 941-226-0206
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Fax | 941-900-1043
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Provider Business Mailing Address
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Address Line | 1313 VINETREE DR
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City | BRANDON
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State | FL
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Zip | 33510-2091
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Country | US
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Telephone | 813-480-3563
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | 123001
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License Number State | FL
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