Provider Demographics
NPI:1639451263
Name:SHAH, MEENA K (MD)
Entity Type:Individual
Prefix:
First Name:MEENA
Middle Name:K
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 SOULE RD
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33759-1507
Mailing Address - Country:US
Mailing Address - Phone:727-726-7442
Mailing Address - Fax:727-288-1111
Practice Address - Street 1:1938 SOULE RD
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33759-1507
Practice Address - Country:US
Practice Address - Phone:727-726-7442
Practice Address - Fax:727-288-1111
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-09
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1106872084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004061200Medicaid
FLFT508ZMedicare PIN