Provider Demographics
NPI:1760034136
Name:SHAH, RAJSHREE (MSN)
Entity Type:Individual
Prefix:MS
First Name:RAJSHREE
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9639 PHIPPS LN
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3405
Mailing Address - Country:US
Mailing Address - Phone:561-313-3174
Mailing Address - Fax:
Practice Address - Street 1:9639 PHIPPS LN
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3405
Practice Address - Country:US
Practice Address - Phone:561-313-3174
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11002662363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily