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General NPI Number Information
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NPI Number | 1902839913
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Entity Type | Organization
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Legal Business Name | VRAJESH SHAH M.D., P.A.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 15953 N FLORIDA AVE
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City | LUTZ
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State | FL
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Zip | 33549-8102
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Country | US
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Telephone | 813-960-4894
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Fax | 813-968-4997
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Provider Business Mailing Address
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Address Line | PO BOX 271447
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City | TAMPA
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State | FL
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Zip | 33688-1447
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Country | US
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Telephone | 813-960-4894
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Fax | 813-968-4997
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MARIE VANESSA MATOS
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Credential |
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Telephone | 813-960-4894
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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 | ME0061405
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License Number State | FL
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