Provider Demographics
NPI:1558328625
Name:SHAH, MANISH (MD)
Entity Type:Individual
Prefix:DR
First Name:MANISH
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 1:713 GOODYEAR AVE
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1156
Mailing Address - Country:US
Mailing Address - Phone:256-492-4040
Mailing Address - Fax:256-492-4017
Practice Address - Street 1:713 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1156
Practice Address - Country:US
Practice Address - Phone:256-492-4040
Practice Address - Fax:256-492-4017
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20701208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC100OtherCLINIC ID-GADSDEN
AL051507493Medicaid
ALC243OtherCLINIC ID-BOAZ
ALC373OtherCLINIC ID-FT PAYNE
H41730Medicare UPIN
AL051507493SHAMedicare ID - Type UnspecifiedMEDICARE ID DR. SHAH