Provider Demographics
NPI:1366460610
Name:SHAH, SAURIN JAYENDRA (MD)
Entity Type:Individual
Prefix:
First Name:SAURIN
Middle Name:JAYENDRA
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:PO BOX 44008
Mailing Address - Street 2:UFJP PROVIDER ENROLLMENT
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32231-4008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:655 W 8TH ST
Practice Address - Street 2:UFJP ANESTHESIOLOGY
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32209-6511
Practice Address - Country:US
Practice Address - Phone:904-244-4195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL26112207L00000X
FLME103324207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051524824OtherBLUE CROSS
AL010033CI21369OtherSECTION 1011
GA852995576AMedicaid
AL009971035Medicaid
AL009971055Medicaid
AL051524787OtherBLUE CROSS
AL051524788OtherBLUE CROSS
AL009971045Medicaid
MS4901341OtherMISSISSIPPI MEDICAID
ALP00167065OtherRAILROAD MEDICARE
GA852995576AMedicaid
AL009971055Medicaid
FLBI752ZMedicare PIN