MEDICARE: VRINDA 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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	DN25970	FL

General Provider Information

NPI Number	:	1922676220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VRINDA SHAH DMD

Provider Business Mailing Address
First Line	:	635 E NEW HAVEN AVE STE 216
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-5463
Country	:	US
Telephone Number	:	352-514-5245
Fax Number	:

Provider Business Practice Location Address
First Line	:	2419 S BABCOCK ST
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32901-5310
Country	:	US
Telephone Number	:	321-323-0048
Fax Number	:

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

Provider Enumeration Date	:	06/14/2021
Last Update Date	:	06/28/2021

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Directions to “ VRINDA SHAH DMD” Practice Location

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