Provider Demographics
NPI:1083617229
Name:SHAH, AJIT (MD)
Entity Type:Individual
Prefix:
First Name:AJIT
Middle Name:
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 1:10069 HART BRANCH CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5913
Mailing Address - Country:US
Mailing Address - Phone:407-282-8243
Mailing Address - Fax:
Practice Address - Street 1:10069 HART BRANCH CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5913
Practice Address - Country:US
Practice Address - Phone:407-282-8243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2013-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96817207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100084540Medicaid
IN293070BMedicare ID - Type Unspecified
INC24778Medicare UPIN