MEDICARE: HEMANT SHAH MD

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	ME0063553	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110130899	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	26992	OTHER		WELLCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	PCP0066	OTHER	FL	QUALITY HEALTH PLAN
5	00430	OTHER	FL	UNIVERSAL
6	201978	OTHER	FL	AMERIGROUP
7	26263	OTHER	FL	BCBS
8	26992	OTHER	FL	WELLCARE
9	6011235	OTHER	FL	GHI
10	ME63553	OTHER	FL	WORK COMP
11	104183	OTHER	FL	AVMED
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295743508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEMANT SHAH MD

Provider Business Mailing Address
First Line	:	PO BOX 21727
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-1727
Country	:	US
Telephone Number	:	727-823-2188
Fax Number	:	727-828-0723

Provider Business Practice Location Address
First Line	:	3306 US HIGHWAY 19
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34691-1846
Country	:	US
Telephone Number	:	727-849-6850
Fax Number	:

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	12/30/2020

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Directions to “ HEMANT SHAH MD” Practice Location

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