Provider Demographics
NPI:1629171988
Name:SHAH, DARSHAN N (MD)
Entity Type:Individual
Prefix:
First Name:DARSHAN
Middle Name:N
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 1:2339 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-5920
Mailing Address - Country:US
Mailing Address - Phone:772-461-1008
Mailing Address - Fax:772-461-0041
Practice Address - Street 1:2339 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5920
Practice Address - Country:US
Practice Address - Phone:772-461-1008
Practice Address - Fax:772-461-0041
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47071207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
B06175Medicare UPIN
18507AMedicare ID - Type Unspecified