Provider Demographics
NPI:1346446911
Name:SHAH, CHETAN CHANDULAL (MBBS)
Entity Type:Individual
Prefix:DR
First Name:CHETAN
Middle Name:CHANDULAL
Last Name:SHAH
Suffix:
Gender:M
Credentials:MBBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 100374
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0374
Mailing Address - Country:US
Mailing Address - Phone:352-265-0291
Mailing Address - Fax:352-265-0279
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-8426
Practice Address - Country:US
Practice Address - Phone:352-265-0291
Practice Address - Fax:352-265-0279
Is Sole Proprietor?:No
Enumeration Date:2007-06-21
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-56772085N0700X, 2085P0229X
DEC100102122085P0229X
FLME1133022085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR170947001Medicaid
FL006569400Medicaid
FL006569400Medicaid