Provider Demographics
NPI:1720281058
Name:SHAH, SYED HADI (MD)
Entity Type:Individual
Prefix:DR
First Name:SYED
Middle Name:HADI
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2420 W MISSISSIPPI AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-6110
Mailing Address - Country:US
Mailing Address - Phone:813-350-9090
Mailing Address - Fax:813-443-5783
Practice Address - Street 1:428 W BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5002
Practice Address - Country:US
Practice Address - Phone:813-681-4444
Practice Address - Fax:813-661-8763
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2021-10-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME108175207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003696100Medicaid
FLCE775ZMedicare PIN