Provider Demographics
NPI:1770552390
Name:SHAH, SURESHCHANDRA O (MD)
Entity type:Individual
Prefix:
First Name:SURESHCHANDRA
Middle Name:O
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1501 PRESIDENTIAL WAY
Mailing Address - Street 2:12
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-1800
Mailing Address - Country:US
Mailing Address - Phone:561-471-9484
Mailing Address - Fax:561-471-9555
Practice Address - Street 1:1501 PRESIDENTIAL WAY
Practice Address - Street 2:12
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-1800
Practice Address - Country:US
Practice Address - Phone:561-471-9484
Practice Address - Fax:561-471-9555
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME31288207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD62728Medicare UPIN
FL50923Medicare ID - Type UnspecifiedMEDICARE