MEDICARE: ASHA SHAH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME103803	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	149V7	OTHER	FL	BCBS OF FL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225128861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHA SHAH M.D.

Provider Business Mailing Address
First Line	:	1000 36TH ST
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32960-4862
Country	:	US
Telephone Number	:	772-567-4311
Fax Number	:	772-563-4723

Provider Business Practice Location Address
First Line	:	1960 POINTE WEST DR
Second Line	:	SUITE 102
City	:	VERO BEACH
State	:	FL
Zip	:	32966-1302
Country	:	US
Telephone Number	:	772-564-7828
Fax Number	:	772-564-6107

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	04/11/2012

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