Provider Demographics
NPI:1003939224
Name:SHAH, NANDKISHOR (MD)
Entity Type:Individual
Prefix:
First Name:NANDKISHOR
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NICK
Other - Middle Name:
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:6450 38TH AVE N
Mailing Address - Street 2:SUITE# 100
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1645
Mailing Address - Country:US
Mailing Address - Phone:727-347-2780
Mailing Address - Fax:727-347-5508
Practice Address - Street 1:6450 38TH AVE N
Practice Address - Street 2:SUITE# 100
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-1645
Practice Address - Country:US
Practice Address - Phone:727-347-2780
Practice Address - Fax:727-347-5508
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0057806207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259995300Medicaid
FL259995300Medicaid
E84308Medicare UPIN