Provider Demographics
NPI:1255778353
Name:SHAH, SANKET S (PA)
Entity type:Individual
Prefix:
First Name:SANKET
Middle Name:S
Last Name:SHAH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DOUGLAS BLVD STE 225
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4283
Mailing Address - Country:US
Mailing Address - Phone:916-740-3721
Mailing Address - Fax:
Practice Address - Street 1:3400 DOUGLAS BLVD STE 225
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4283
Practice Address - Country:US
Practice Address - Phone:916-740-3721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-29
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07006363AM0700X
CA60707363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical