Provider Demographics
NPI:1619688769
Name:SHAH, RAJESH B
Entity Type:Individual
Prefix:
First Name:RAJESH
Middle Name:B
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3806 SLAZENGER CT
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-4737
Mailing Address - Country:US
Mailing Address - Phone:513-200-7906
Mailing Address - Fax:
Practice Address - Street 1:3806 SLAZENGER CT
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-4737
Practice Address - Country:US
Practice Address - Phone:513-200-7906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant