Provider Demographics
NPI:1114161320
Name:SHAH, JAIMIN GIRISH (MD)
Entity Type:Individual
Prefix:DR
First Name:JAIMIN
Middle Name:GIRISH
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 1:620 10TH ST N STE 3D
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1407
Mailing Address - Country:US
Mailing Address - Phone:727-824-7146
Mailing Address - Fax:727-824-7119
Practice Address - Street 1:620 10TH ST N
Practice Address - Street 2:SUITE 3D
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-1407
Practice Address - Country:US
Practice Address - Phone:727-824-7146
Practice Address - Fax:727-824-7119
Is Sole Proprietor?:No
Enumeration Date:2009-05-01
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36581208800000X
FLME124469208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL015054700Medicaid
FLII539ZMedicare PIN