Provider Demographics
NPI:1225376700
Name:YOGESH H SHAH MD PA
Entity Type:Organization
Organization Name:YOGESH H SHAH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARDIOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YOGESH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-426-2060
Mailing Address - Street 1:501 LIVE OAK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7312
Mailing Address - Country:US
Mailing Address - Phone:386-426-2060
Mailing Address - Fax:386-426-6533
Practice Address - Street 1:501 LIVE OAK ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7312
Practice Address - Country:US
Practice Address - Phone:386-426-2060
Practice Address - Fax:386-426-6533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61678261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC55130Medicare UPIN