Provider Demographics
NPI:1225128861
Name:SHAH, ASHA (MD)
Entity Type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 36TH ST
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-4862
Mailing Address - Country:US
Mailing Address - Phone:772-567-4311
Mailing Address - Fax:772-563-4723
Practice Address - Street 1:1960 POINTE WEST DR
Practice Address - Street 2:SUITE 102
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-1302
Practice Address - Country:US
Practice Address - Phone:772-564-7828
Practice Address - Fax:772-564-6107
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2012-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME103803207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002719600Medicaid
FL149V7OtherBCBS OF FL
FLDQ753ZMedicare PIN