Provider Demographics
NPI:1356427603
Name:NAYANA SHAH M.D. INC.
Entity type:Organization
Organization Name:NAYANA SHAH M.D. INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-583-0925
Mailing Address - Street 1:24551 RAYMOND WAY
Mailing Address - Street 2:#200
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-4400
Mailing Address - Country:US
Mailing Address - Phone:949-583-0925
Mailing Address - Fax:949-583-7973
Practice Address - Street 1:16152 BEACH BLVD
Practice Address - Street 2:#200
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3806
Practice Address - Country:US
Practice Address - Phone:714-841-6772
Practice Address - Fax:714-841-6775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37530101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty