Provider Demographics
NPI:1578545257
Name:SHAH, KRINA A (MD)
Entity Type:Individual
Prefix:
First Name:KRINA
Middle Name:A
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRINA
Other - Middle Name:ARUNKUMAR
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 618347
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32861-8347
Mailing Address - Country:US
Mailing Address - Phone:407-445-9545
Mailing Address - Fax:407-445-9365
Practice Address - Street 1:1507 S HIAWASSEE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-5718
Practice Address - Country:US
Practice Address - Phone:407-445-9545
Practice Address - Fax:407-445-9365
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84131207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265365100Medicaid
H73996Medicare UPIN
920228185602Medicare ID - Type Unspecified
FL13923AMedicare PIN