Provider Demographics
NPI:1346426566
Name:SHAH, SUJAL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUJAL
Middle Name:
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 1:1630 S CONGRESS AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33461-2171
Mailing Address - Country:US
Mailing Address - Phone:561-253-3980
Mailing Address - Fax:561-253-3985
Practice Address - Street 1:1630 S CONGRESS AVE STE 200
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33461-2171
Practice Address - Country:US
Practice Address - Phone:561-253-3980
Practice Address - Fax:561-253-3985
Is Sole Proprietor?:No
Enumeration Date:2008-01-17
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15552207RX0202X
TXN1136207RX0202X
FLME119608207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH32001101Medicaid
NH002499101Medicare PIN