Provider Demographics
NPI:1013015270
Name:SHAH, ASHVIN K (MD)
Entity Type:Individual
Prefix:
First Name:ASHVIN
Middle Name:K
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 1:2110 W 24TH ST
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-8878
Mailing Address - Country:US
Mailing Address - Phone:928-344-1891
Mailing Address - Fax:928-726-6306
Practice Address - Street 1:2110 W 24TH ST
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-8878
Practice Address - Country:US
Practice Address - Phone:928-344-1891
Practice Address - Fax:928-726-6306
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ14383207RC0200X, 207RP1001X, 207RS0012X
CO14383207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ232421Medicaid
AZD37626Medicare UPIN