Provider Demographics
NPI:1225267297
Name:SHAH, RACHIT MUKESHBHAI (MBBS, MD)
Entity Type:Individual
Prefix:
First Name:RACHIT
Middle Name:MUKESHBHAI
Last Name:SHAH
Suffix:
Gender:M
Credentials:MBBS, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6633 FOREST AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2612
Mailing Address - Country:US
Mailing Address - Phone:277-248-6117
Mailing Address - Fax:727-724-0425
Practice Address - Street 1:6633 FOREST AVE STE 300
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-2612
Practice Address - Country:US
Practice Address - Phone:277-248-6117
Practice Address - Fax:727-724-0425
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125.055761207R00000X
VA390200000X
AL35104207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program