Provider Demographics
NPI: | 1437191244 |
---|---|
Name: | SHAH, SAILESH NARESH (DO) |
Entity Type: | Individual |
Prefix: | |
First Name: | SAILESH |
Middle Name: | NARESH |
Last Name: | SHAH |
Suffix: | |
Gender: | M |
Credentials: | DO |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 38135 MARKET SQ |
Mailing Address - Street 2: | |
Mailing Address - City: | ZEPHYRHILLS |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33542-7505 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 813-528-4975 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 13311 N 56TH ST |
Practice Address - Street 2: | |
Practice Address - City: | TAMPA |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33617-1161 |
Practice Address - Country: | US |
Practice Address - Phone: | 813-284-2220 |
Practice Address - Fax: | 813-377-1718 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-13 |
Last Update Date: | 2021-08-27 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | OS9430 | 207RC0200X, 207RP1001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 275778800 | Medicaid | |
FL | P00977996 | Other | RR MEDICARE |
FL | P00977996 | Other | RR MEDICARE |