MEDICARE: NISHIT SHASHIKANT 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	208000000X	Pediatrics Physician	A167291	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P7349	OTHER	TX	TEXAS MEDICAL LICENCE

General Provider Information

NPI Number	:	1316259864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NISHIT SHASHIKANT SHAH M.D

Provider Business Mailing Address
First Line	:	5504 MONTEREY HWY
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95138-1529
Country	:	US
Telephone Number	:	510-770-8040
Fax Number	:

Provider Business Practice Location Address
First Line	:	40910 FREMONT BLVD STE 300
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-4375
Country	:	US
Telephone Number	:	510-770-8040
Fax Number	:	510-770-8141

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

Provider Enumeration Date	:	07/12/2010
Last Update Date	:	12/29/2025

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