Provider Demographics
NPI:1720252844
Name:SHAH, PARAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:PARAS
Middle Name:A
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 1:10835 N 25TH AVE
Mailing Address - Street 2:STE 240
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85029-3458
Mailing Address - Country:US
Mailing Address - Phone:602-246-2584
Mailing Address - Fax:
Practice Address - Street 1:1760 E PECOS RD STE 101
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85295-3201
Practice Address - Country:US
Practice Address - Phone:913-642-4900
Practice Address - Fax:913-381-0979
Is Sole Proprietor?:No
Enumeration Date:2008-04-18
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ406152085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ620906Medicaid
AZZ158542Medicare PIN
AZZ146161Medicare PIN