Provider Demographics
NPI:1083098206
Name:SHAH, MONA NANDKISHOR (DO)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:NANDKISHOR
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12858 BERRYPICK TRL
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3782
Mailing Address - Country:US
Mailing Address - Phone:727-421-5145
Mailing Address - Fax:
Practice Address - Street 1:1015 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-5636
Practice Address - Country:US
Practice Address - Phone:727-935-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-17
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLUO44722084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry