MEDICARE: DR. YESHA PATEL SHAH DMD

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	1223G0001X	General Practice Dentistry	DN 21937	FL

General Provider Information

NPI Number	:	1801246160
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. YESHA PATEL SHAH DMD

Provider Business Mailing Address
First Line	:	4838 SOUTHLAWN AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-7610
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2105 HARTWOOD MARSH RD STE 3
Second Line	:
City	:	CLERMONT
State	:	FL
Zip	:	34711-5390
Country	:	US
Telephone Number	:	352-536-9644
Fax Number	:

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

Provider Enumeration Date	:	06/17/2016
Last Update Date	:	09/24/2020

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