Provider Demographics
NPI:1639117997
Name:SHAH, YOGESH H (MD)
Entity Type:Individual
Prefix:DR
First Name:YOGESH
Middle Name:H
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 1:501 LIVE OAK ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-7312
Mailing Address - Country:US
Mailing Address - Phone:386-426-2060
Mailing Address - Fax:386-426-6533
Practice Address - Street 1:501 LIVE OAK ST
Practice Address - Street 2:SUITE A
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-7312
Practice Address - Country:US
Practice Address - Phone:386-426-2060
Practice Address - Fax:386-426-6533
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61678207RC0000X
NJ25MA04049300207RC0000X
VA0101042153207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71773Medicare ID - Type Unspecified
FLC55130Medicare UPIN