Provider Demographics
NPI:1144424722
Name:SHAH, SWATI M (MBBS)
Entity Type:Individual
Prefix:DR
First Name:SWATI
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:SWATI
Other - Middle Name:RASIKLAL
Other - Last Name:MODI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 45443
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84145-0443
Mailing Address - Country:US
Mailing Address - Phone:904-202-1032
Mailing Address - Fax:904-376-4107
Practice Address - Street 1:1660 PRUDENTIAL DR
Practice Address - Street 2:SUITE 310
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8197
Practice Address - Country:US
Practice Address - Phone:904-396-8656
Practice Address - Fax:904-396-5931
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98418207R00000X, 207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA163413836AMedicaid
FL2784947-00Medicaid
FLP01321209OtherRAILROAD MEDICARE
FL2784947-00Medicaid
FLAE424ZMedicare PIN
944711999OtherMYUTMB 944711999-COMMERCIAL NUMBER
GA163413836AMedicaid
FLAE424WMedicare PIN