Provider Demographics
NPI:1508937442
Name:SHAH, NILESH H (MD)
Entity Type:Individual
Prefix:
First Name:NILESH
Middle Name:H
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 1:1519 GARCES HWY
Mailing Address - Street 2:105
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215
Mailing Address - Country:US
Mailing Address - Phone:661-725-8585
Mailing Address - Fax:661-725-8512
Practice Address - Street 1:1519 GARCES HWY
Practice Address - Street 2:105
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215
Practice Address - Country:US
Practice Address - Phone:661-725-8585
Practice Address - Fax:661-725-8512
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA44507208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A445070OtherMEDI CAL
1982833Medicare UPIN