Provider Demographics
NPI:1548792534
Name:SHAH, JINIT (NP-C)
Entity Type:Individual
Prefix:
First Name:JINIT
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9144 COUNTRYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-5726
Mailing Address - Country:US
Mailing Address - Phone:734-772-4722
Mailing Address - Fax:
Practice Address - Street 1:31500 W 13 MILE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2164
Practice Address - Country:US
Practice Address - Phone:734-772-4722
Practice Address - Fax:248-509-4080
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704278297363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily