MEDICARE: SHAILEE 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	207RC0000X	Cardiovascular Disease Physician	ME154819	FL
2	207R00000X	Internal Medicine Physician	35.132016	OH

General Provider Information

NPI Number	:	1568857852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAILEE SHAH MD

Provider Business Mailing Address
First Line	:	300 SAINT ELIZABETH WAY STE 110
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-1153
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 SAINT ELIZABETH WAY STE 110
Second Line	:
City	:	ST JOHNS
State	:	FL
Zip	:	32259-1153
Country	:	US
Telephone Number	:	904-691-9100
Fax Number	:

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

Provider Enumeration Date	:	04/02/2015
Last Update Date	:	10/22/2024

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Directions to “ SHAILEE SHAH MD” Practice Location

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