Provider Demographics
NPI:1417966219
Name:SHAH, MAULIK RAJ (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:MAULIK
Middle Name:RAJ
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7550 W UNIVERSITY AVE
Mailing Address - Street 2:SUTE B
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-7608
Mailing Address - Country:US
Mailing Address - Phone:352-235-9636
Mailing Address - Fax:877-465-6936
Practice Address - Street 1:7550 W UNIVERSITY AVE
Practice Address - Street 2:SUTE B
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-7608
Practice Address - Country:US
Practice Address - Phone:352-235-9636
Practice Address - Fax:877-465-6936
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002014672207SG0201X, 208000000X
FLME107485207R00000X, 207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205999006Medicaid
FL007181600Medicaid
MO205999006Medicaid
FLGY149ZMedicare PIN
FL007181600Medicaid