MEDICARE: MINDY S 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	231472	NY
2	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	72725	MN
3	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	20072	ND
4	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	231472	NY
5	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	63930	WI
6	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	231472	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518905348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY S SHAH MD

Provider Business Mailing Address
First Line	:	50 S B B KING BLVD STE 100
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38103-2626
Country	:	US
Telephone Number	:	866-949-0108
Fax Number	:

Provider Business Practice Location Address
First Line	:	6737 W WASHINGTON ST STE 2150
Second Line	:
City	:	WEST ALLIS
State	:	WI
Zip	:	53214-5649
Country	:	US
Telephone Number	:	608-224-9371
Fax Number	:

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

Provider Enumeration Date	:	06/03/2006
Last Update Date	:	06/18/2025

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Directions to “ MINDY S SHAH MD” Practice Location

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