Provider Demographics
NPI:1326026931
Name:SHAH, SAURIN J (MD)
Entity type:Individual
Prefix:
First Name:SAURIN
Middle Name:J
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 1:845 S TOWN AND RIVER DRIVE
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919
Mailing Address - Country:US
Mailing Address - Phone:239-454-2742
Mailing Address - Fax:239-466-2742
Practice Address - Street 1:845 S TOWN AND RIVER DRIVE
Practice Address - Street 2:
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919
Practice Address - Country:US
Practice Address - Phone:239-454-2742
Practice Address - Fax:239-466-2742
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME828262085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00273509OtherRAILROAD PROVIDER NUMBER
FL267956300Medicaid
FL267956300Medicaid
FLP00273509OtherRAILROAD PROVIDER NUMBER