Provider Demographics
NPI:1962458190
Name:SHAH, NILESH (MD)
Entity Type:Individual
Prefix:
First Name:NILESH
Middle Name:
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 1:20 OLIVE ST STE 201
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44310-3169
Mailing Address - Country:US
Mailing Address - Phone:330-379-5051
Mailing Address - Fax:330-379-5074
Practice Address - Street 1:20 OLIVE ST STE 201
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44310-3169
Practice Address - Country:US
Practice Address - Phone:330-379-5051
Practice Address - Fax:330-379-5074
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-076963207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2458165Medicaid
OH2458165Medicaid
OHSH4111752Medicare ID - Type Unspecified