Provider Demographics
NPI:1245261650
Name:SHAH, SANJAY GUNVANTLAL (MD)
Entity type:Individual
Prefix:DR
First Name:SANJAY
Middle Name:GUNVANTLAL
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 1:713 VOLVO PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-1614
Mailing Address - Country:US
Mailing Address - Phone:757-282-4150
Mailing Address - Fax:
Practice Address - Street 1:713 VOLVO PKWY STE 200
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-1614
Practice Address - Country:US
Practice Address - Phone:757-282-4150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101052810207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA269859OtherANTHEM
VAPAROtherAETNA
VA-001OtherTRICARE/CHAMPUS
VA010226562Medicaid
VA10015733OtherSENTARA OPTIMA
VAPAROtherMULTIPLAN
VAPAROtherVIRGINIA PREMIER HEALTH
VA441762OtherMAMSI
VA187096OtherANTHEM BC/BS
NC7906232Medicaid
VAPAROtherCORVEL/CORCARE
VAPAROtherUSA MANAGED CARE
VAPAROtherVIRGINIA HEALTH NETWORK
VAPAROtherFIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY
NC06232OtherBC/BS
VA1245261650Medicaid
VAPAROtherCIGNA
VA35167OtherOPTIMA HEALTH PLAN
VA641762OtherUHC/MAMSI
VAPAROtherCORVEL/CORCARE
VAG15554Medicare UPIN
VA441762OtherMAMSI
VAPAROtherMULTIPLAN
VAPAROtherVIRGINIA PREMIER HEALTH