MEDICARE: DR. MINAL 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	207R00000X	Internal Medicine Physician	189767	NY
2	208D00000X	General Practice Physician	189767	NY
3	207Q00000X	Family Medicine Physician	189767	NY
4	208M00000X	Hospitalist Physician	189767	NY

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

General Provider Information

NPI Number	:	1417936501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINAL SHAH MD

Provider Business Mailing Address
First Line	:	PO BOX 947
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-0079
Country	:	US
Telephone Number	:	516-477-0008
Fax Number	:	516-677-0107

Provider Business Practice Location Address
First Line	:	110 COACHMAN PLACE WEST
Second Line	:
City	:	SYOSSET
State	:	NY
Zip	:	11791-3052
Country	:	US
Telephone Number	:	516-477-0008
Fax Number	:	516-677-0107

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

Provider Enumeration Date	:	01/17/2006
Last Update Date	:	01/04/2017

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Directions to “ DR. MINAL SHAH MD” Practice Location

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