Provider Demographics
NPI:1417123605
Name:SHAH, SNEHAL (MD)
Entity Type:Individual
Prefix:DR
First Name:SNEHAL
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10700 BEACH BLVD UNIT 16348
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-8014
Mailing Address - Country:US
Mailing Address - Phone:904-604-8850
Mailing Address - Fax:716-237-4199
Practice Address - Street 1:6100 GREENLAND RD STE 905
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32258-2453
Practice Address - Country:US
Practice Address - Phone:904-604-8850
Practice Address - Fax:716-237-4199
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA092847002084P0800X
CT491882084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry