Provider Demographics
NPI:1003845488
Name:SHETH, JAYESH (MD)
Entity Type:Individual
Prefix:
First Name:JAYESH
Middle Name:
Last Name:SHETH
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 1:6823 HIGHWAY 311
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1801
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6823 HIGHWAY 311
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1801
Practice Address - Country:US
Practice Address - Phone:812-246-9809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01053906A207Q00000X, 207QG0300X
KY36086207Q00000X
GA058507207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200326370Medicaid
KY64036304Medicaid
P00422955OtherRAILROAD MEDICARE
P00422955OtherRAILROAD MEDICARE
H32174Medicare UPIN
GA511I080455Medicare PIN
IN200326370Medicaid