Provider Demographics
NPI:1053660886
Name:SHAH, KAIRAV RAMESHCHANDRA (MD)
Entity Type:Individual
Prefix:
First Name:KAIRAV
Middle Name:RAMESHCHANDRA
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 1:1524 MCHENRY AVE STE 445
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4573
Mailing Address - Country:US
Mailing Address - Phone:209-571-1693
Mailing Address - Fax:
Practice Address - Street 1:1524 MCHENRY AVE STE 445
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4573
Practice Address - Country:US
Practice Address - Phone:209-571-1693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2689422084P0800X
FLME134702208VP0000X
CAA1420952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine