Provider Demographics
NPI:1154326973
Name:SHAH, HEMANT N (MD)
Entity Type:Individual
Prefix:DR
First Name:HEMANT
Middle Name:N
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 600290
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32260-0290
Mailing Address - Country:US
Mailing Address - Phone:904-268-8200
Mailing Address - Fax:904-268-8298
Practice Address - Street 1:9421 WAYPOINT PL
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-9229
Practice Address - Country:US
Practice Address - Phone:904-268-8200
Practice Address - Fax:904-268-8298
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME95262208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAI 260Medicare PIN