Provider Demographics
NPI:1194177857
Name:NILAM D SHAH PA
Entity Type:Organization
Organization Name:NILAM D SHAH PA
Other - Org Name:SUNRISE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NILAMBEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-417-0233
Mailing Address - Street 1:5778 5TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-7104
Mailing Address - Country:US
Mailing Address - Phone:727-388-2625
Mailing Address - Fax:727-828-9233
Practice Address - Street 1:5778 5TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-7104
Practice Address - Country:US
Practice Address - Phone:727-388-2625
Practice Address - Fax:727-828-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-06
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020378900Medicaid