Provider Demographics
NPI:1366632440
Name:SHAH, JAY (MD)
Entity Type:Individual
Prefix:MR
First Name:JAY
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 1:5541 TELEGRAPH ROAD
Mailing Address - Street 2:#216
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-3554
Mailing Address - Country:US
Mailing Address - Phone:347-610-3199
Mailing Address - Fax:
Practice Address - Street 1:5541 TELEGRAPH ROAD
Practice Address - Street 2:#216
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-3554
Practice Address - Country:US
Practice Address - Phone:347-610-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-26
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9C76207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine