Provider Demographics
NPI:1922000751
Name:SHAH, NEENAD MAHENDRA (MD)
Entity Type:Individual
Prefix:
First Name:NEENAD
Middle Name:MAHENDRA
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:PO BOX 746654
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6654
Mailing Address - Country:US
Mailing Address - Phone:904-202-2092
Mailing Address - Fax:904-393-7603
Practice Address - Street 1:1301 PALM AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8432
Practice Address - Country:US
Practice Address - Phone:904-202-7300
Practice Address - Fax:904-202-7433
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME901972085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1098377OtherWELLCARE
FL1193468OtherWELLCARE
FLP01451923OtherRR MEDICARE
FL7633639OtherAETNA
FL299017OtherAVMED
FL3625970OtherCIGNA
FL44111OtherBCBS
FL1115825OtherCARE PLUS
FLP015696540OtherRR MEDICARE
FL269981800Medicaid
FL44111OtherBCBS
FLP015696540OtherRR MEDICARE
FLU3494QMedicare PIN
FLU3494SMedicare PIN
FLU3494MMedicare PIN
FLU3494CMedicare PIN
FLP01451923OtherRR MEDICARE
FL299017OtherAVMED
FL269981800Medicaid
FLU3494RMedicare PIN
FLU3494IMedicare PIN
FL1193468OtherWELLCARE
FLI18473Medicare UPIN
FLU3494UMedicare PIN
FLU3494FMedicare PIN
FLU3494EMedicare PIN
FL1115825OtherCARE PLUS
FLU3494LMedicare PIN
FLU3494HMedicare PIN