Provider Demographics
NPI:1568797553
Name:SHAH, NANDAN (MD)
Entity Type:Individual
Prefix:
First Name:NANDAN
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 1:604 OAK COMMONS BLVD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4198
Mailing Address - Country:US
Mailing Address - Phone:407-846-6004
Mailing Address - Fax:407-846-1330
Practice Address - Street 1:604 OAK COMMONS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4198
Practice Address - Country:US
Practice Address - Phone:407-846-6004
Practice Address - Fax:407-846-1330
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME132696207X00000X, 207XS0117X
NJ25MA11516300207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery