Provider Demographics
NPI:1295743508
Name:SHAH, HEMANT (MD)
Entity type:Individual
Prefix:
First Name:HEMANT
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:PO BOX 21727
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33622-1727
Mailing Address - Country:US
Mailing Address - Phone:727-823-2188
Mailing Address - Fax:727-828-0723
Practice Address - Street 1:3306 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-1846
Practice Address - Country:US
Practice Address - Phone:727-849-6850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0063553207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110130899OtherRAILROAD MEDICARE
26992OtherWELLCARE
FL379627201Medicaid
FLPCP0066OtherQUALITY HEALTH PLAN
FL00430OtherUNIVERSAL
FL201978OtherAMERIGROUP
FL26263OtherBCBS
FL26992OtherWELLCARE
FL6011235OtherGHI
FLME63553OtherWORK COMP
FL104183OtherAVMED
FL26263OtherBCBS
FL26263ZMedicare PIN