Provider Demographics
NPI:1447221544
Name:SHAH, JATIN (MD)
Entity Type:Individual
Prefix:
First Name:JATIN
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:PO BOX 2099
Mailing Address - Street 2:
Mailing Address - City:SUN CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:85372-2099
Mailing Address - Country:US
Mailing Address - Phone:855-506-3876
Mailing Address - Fax:855-523-0513
Practice Address - Street 1:10474 W THUNDERBIRD BLVD
Practice Address - Street 2:STE 200
Practice Address - City:SUN CITY
Practice Address - State:AZ
Practice Address - Zip Code:85351-3015
Practice Address - Country:US
Practice Address - Phone:855-506-3876
Practice Address - Fax:855-523-0513
Is Sole Proprietor?:No
Enumeration Date:2006-01-28
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ28642174400000X, 2084N0400X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No174400000XOther Service ProvidersSpecialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ549818Medicaid
AZ64090Medicare PIN
AZE52020Medicare UPIN