Provider Demographics
NPI:1003040981
Name:SHAH, AKSHAY VIJAY (MD)
Entity Type:Individual
Prefix:DR
First Name:AKSHAY
Middle Name:VIJAY
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14155 N 83RD AVE
Mailing Address - Street 2:SUITE 122
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-5639
Mailing Address - Country:US
Mailing Address - Phone:623-773-1161
Mailing Address - Fax:623-773-1181
Practice Address - Street 1:14155 N 83RD AVE
Practice Address - Street 2:SUITE 122
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-5639
Practice Address - Country:US
Practice Address - Phone:623-773-1161
Practice Address - Fax:623-773-1181
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY251288207R00000X
AZ42590207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ509244Medicaid