Provider Demographics
NPI:1952462350
Name:SIDDHARTH H SHAH MD PA
Entity Type:Organization
Organization Name:SIDDHARTH H SHAH MD PA
Other - Org Name:BAY VIEW NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SIDDHARTH
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-848-0800
Mailing Address - Street 1:PO BOX 768
Mailing Address - Street 2:
Mailing Address - City:ELFERS
Mailing Address - State:FL
Mailing Address - Zip Code:34680-0768
Mailing Address - Country:US
Mailing Address - Phone:727-848-0800
Mailing Address - Fax:727-843-8157
Practice Address - Street 1:4762 ROWAN RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34653-5601
Practice Address - Country:US
Practice Address - Phone:727-848-0800
Practice Address - Fax:727-843-8157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL256701600Medicaid
FL256701600Medicaid
FLK0791Medicare ID - Type Unspecified