MEDICARE: NEENAD MAHENDRA 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	2085R0001X	Radiation Oncology Physician	ME90197	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
8	P01451923	OTHER	FL	RR MEDICARE
9	P015696540	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1115825	OTHER	FL	CARE PLUS
2	3625970	OTHER	FL	CIGNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	299017	OTHER	FL	AVMED
5	7633639	OTHER	FL	AETNA
6	44111	OTHER	FL	BCBS
7	1098377	OTHER	FL	WELLCARE
10	1193468	OTHER	FL	WELLCARE
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922000751
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEENAD MAHENDRA SHAH MD

Provider Business Mailing Address
First Line	:	PO BOX 746654
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6654
Country	:	US
Telephone Number	:	904-202-2092
Fax Number	:	904-376-4075

Provider Business Practice Location Address
First Line	:	2310 VILLAGE SQUARE PKWY STE 106C
Second Line	:
City	:	FLEMING ISLAND
State	:	FL
Zip	:	32003-6409
Country	:	US
Telephone Number	:	904-202-7300
Fax Number	:	904-202-2754

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

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	01/16/2026

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