Provider Demographics
NPI:1770697187
Name:JAYESH S SHAH MD
Entity type:Organization
Organization Name:JAYESH S SHAH MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAYESH
Authorized Official - Middle Name:S
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-935-0222
Mailing Address - Street 1:1426 W BUSCH BLVD
Mailing Address - Street 2:STE 105
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7602
Mailing Address - Country:US
Mailing Address - Phone:813-433-1002
Mailing Address - Fax:813-877-6330
Practice Address - Street 1:1426 W BUSCH BLVD
Practice Address - Street 2:STE 105
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7602
Practice Address - Country:US
Practice Address - Phone:813-935-0222
Practice Address - Fax:813-877-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
390003723OtherRAILROAD MEDICARE