Provider Demographics
NPI:1235301409
Name:SHAH, RUCHI GANDHI (ARNP)
Entity Type:Individual
Prefix:
First Name:RUCHI
Middle Name:GANDHI
Last Name:SHAH
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:RUCHI
Other - Middle Name:GANDHI
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:668 N ORLANDO AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32751-4459
Mailing Address - Country:US
Mailing Address - Phone:407-774-2431
Mailing Address - Fax:407-774-9473
Practice Address - Street 1:668 N ORLANDO AVE STE 105
Practice Address - Street 2:
Practice Address - City:MAITLAND
Practice Address - State:FL
Practice Address - Zip Code:32751-4459
Practice Address - Country:US
Practice Address - Phone:407-774-2431
Practice Address - Fax:407-774-9473
Is Sole Proprietor?:No
Enumeration Date:2008-03-28
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9220986363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001237700Medicaid
FLAL848YMedicare PIN