Provider Demographics
NPI:1003218025
Name:SHAH, AMIT (PA-C)
Entity Type:Individual
Prefix:MR
First Name:AMIT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE #101
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2657
Mailing Address - Country:US
Mailing Address - Phone:951-657-6559
Mailing Address - Fax:
Practice Address - Street 1:2226 MEDICAL CENTER DR
Practice Address - Street 2:SUITE #101
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-2657
Practice Address - Country:US
Practice Address - Phone:951-657-6559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-22
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51942363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant