MEDICARE: SIDDHARTH SHAH

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	242T00000X	Perfusionist	129082	CA

General Provider Information

NPI Number	:	1306347984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIDDHARTH SHAH

Provider Business Mailing Address
First Line	:	4000 PRESIDENTIAL BLVD
Second Line	:	APT# 1119
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131
Country	:	US
Telephone Number	:	732-725-2323
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 PRESIDENTIAL BLVD APT 1119
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19131-1721
Country	:	US
Telephone Number	:	732-725-2323
Fax Number	:

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

Provider Enumeration Date	:	02/28/2018
Last Update Date	:	02/28/2018

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Directions to “ SIDDHARTH SHAH ” Practice Location

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