Provider Demographics
NPI:1942629423
Name:SHAH, UDAYAN KANDARP (MD)
Entity Type:Individual
Prefix:DR
First Name:UDAYAN
Middle Name:KANDARP
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 1:6569 N RIVERSIDE DR # 102504
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93722-9318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:518 N COURT ST STE B
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-4920
Practice Address - Country:US
Practice Address - Phone:559-625-9100
Practice Address - Fax:559-625-9103
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2020-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA142144207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine