Provider Demographics
NPI:1740921808
Name:SHAH, HIMADRI (DO)
Entity type:Individual
Prefix:
First Name:HIMADRI
Middle Name:
Last Name:SHAH
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 W COMMERCIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319-2129
Mailing Address - Country:US
Mailing Address - Phone:954-644-8800
Mailing Address - Fax:954-824-1901
Practice Address - Street 1:7401 W COMMERCIAL BLVD
Practice Address - Street 2:
Practice Address - City:LAUDERHILL
Practice Address - State:FL
Practice Address - Zip Code:33319-2129
Practice Address - Country:US
Practice Address - Phone:954-644-8800
Practice Address - Fax:954-824-1901
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS21840207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine