Provider Demographics
NPI:1861488140
Name:SHAH, RINA V (PA-C)
Entity Type:Individual
Prefix:
First Name:RINA
Middle Name:V
Last Name:SHAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:RINA
Other - Middle Name:
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3400 W 66TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2167
Mailing Address - Country:US
Mailing Address - Phone:952-832-0805
Mailing Address - Fax:952-832-5597
Practice Address - Street 1:6405 FRANCE AVE S STE W440
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2190
Practice Address - Country:US
Practice Address - Phone:952-927-7004
Practice Address - Fax:952-927-5146
Is Sole Proprietor?:No
Enumeration Date:2005-09-22
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20882363AS0400X
DEC50000486363AS0400X
MI5601005074363AS0400X
MN10902363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical