MEDICARE: HEMANT N SHAH MD LLC

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

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CH8693	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38839	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1841207446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEMANT N SHAH MD LLC

Provider Business Mailing Address
First Line	:	PO BOX 21727
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33622-1727
Country	:	US
Telephone Number	:	727-823-2188
Fax Number	:	727-828-0723

Provider Business Practice Location Address
First Line	:	3306 US HIGHWAY 19
Second Line	:
City	:	HOLIDAY
State	:	FL
Zip	:	34691-1846
Country	:	US
Telephone Number	:	727-849-6850
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	HEMANT N SHAH
Credential	:
Telephone Number	:	727-849-6850

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/24/2024

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