Provider Demographics
NPI:1275858516
Name:SHAH, KAUSHAL YOGESHBHAI (MD)
Entity Type:Individual
Prefix:DR
First Name:KAUSHAL
Middle Name:YOGESHBHAI
Last Name:SHAH
Suffix:
Gender:M
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:CORNER OF LAMONT & VETERANS WAY
Mailing Address - Street 2:MOUNTAIN HOME VA MEDICAL CENTER
Mailing Address - City:MOUNTAIN HOME
Mailing Address - State:TN
Mailing Address - Zip Code:37684
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:
Practice Address - Street 1:CORNER OF LAMONT & VETERANS WAY
Practice Address - Street 2:MOUNTAIN HOME VA MEDICAL CENTER
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-30
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01012559762084P0800X
TN536102084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVJ376B288Medicare PIN
TN103I265767Medicare PIN