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NPI Code Detail

MEDICARE: SUPRIYA HEMANT SHAH

MEDICARE: SUPRIYA HEMANT 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
1390200000XStudent in an Organized Health Care Education/Training Program
2208100000XPhysical Medicine & Rehabilitation PhysicianME140027FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1437543519
Entity Type Code : Individual
Provider Name (Legal Business Name) : SUPRIYA HEMANT SHAH
Provider Business Mailing Address
First Line : 3535 SOUTHERN BLVD
Second Line :
City : KETTERING
State : OH
Zip : 45429-1221
Country : US
Telephone Number : 937-384-6800
Fax Number : 937-384-6938
Provider Business Practice Location Address
First Line : 831 S STATE ROAD 434
Second Line :
City : ALTAMONTE SPRINGS
State : FL
Zip : 32714-3502
Country : US
Telephone Number : 937-266-5188
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/26/2015
Last Update Date : 04/21/2022

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Directions to “ SUPRIYA HEMANT SHAH ” Practice Location

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