MEDICARE: AMI 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	225100000X	Physical Therapist	26107	MD

General Provider Information

NPI Number	:	1518417674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMI SHAH

Provider Business Mailing Address
First Line	:	2122 YORK RD STE 300
Second Line	:
City	:	OAK BROOK
State	:	IL
Zip	:	60523-1925
Country	:	US
Telephone Number	:
Fax Number	:	410-648-4878

Provider Business Practice Location Address
First Line	:	31 MAGOTHY BEACH RD STE 105
Second Line	:
City	:	PASADENA
State	:	MD
Zip	:	21122-4423
Country	:	US
Telephone Number	:	410-437-3333
Fax Number	:	410-437-4042

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

Provider Enumeration Date	:	10/12/2016
Last Update Date	:	11/20/2024

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Directions to “ AMI SHAH ” Practice Location

Language	Start Address	Practice Location

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