Provider Demographics
NPI:1124040514
Name:SHAH, MAHENDRA B (MD)
Entity Type:Individual
Prefix:
First Name:MAHENDRA
Middle Name:B
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 1:514 SPRING CLUB DRIVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714
Mailing Address - Country:US
Mailing Address - Phone:407-831-5211
Mailing Address - Fax:407-831-5210
Practice Address - Street 1:106 BOSTON AVE
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4731
Practice Address - Country:US
Practice Address - Phone:407-831-5211
Practice Address - Fax:407-831-5210
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00568572084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry