Provider Demographics
NPI:1093162059
Name:SHAH, MANASI SANJIV (MD)
Entity Type:Individual
Prefix:
First Name:MANASI
Middle Name:SANJIV
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 W BRAMBLETON AVE
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23510-1005
Mailing Address - Country:US
Mailing Address - Phone:757-446-5908
Mailing Address - Fax:757-446-5084
Practice Address - Street 1:855 W BRAMBLETON AVE
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23510-1005
Practice Address - Country:US
Practice Address - Phone:757-446-5908
Practice Address - Fax:757-446-5084
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2021-09-16
Deactivation Date:2017-01-10
Deactivation Code:
Reactivation Date:2018-04-05
Provider Licenses
StateLicense IDTaxonomies
VA0101272210207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism