Provider Demographics
NPI:1851349294
Name:SHAH, SANJAY S (MD)
Entity Type:Individual
Prefix:
First Name:SANJAY
Middle Name:S
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 1:1650 1ST AVE NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5431
Mailing Address - Country:US
Mailing Address - Phone:319-362-3937
Mailing Address - Fax:319-362-2900
Practice Address - Street 1:1650 1ST AVE NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5431
Practice Address - Country:US
Practice Address - Phone:319-362-3937
Practice Address - Fax:319-362-2900
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28633207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0083519Medicaid
IA08209Medicare ID - Type Unspecified
IA0083519Medicaid