Provider Demographics
NPI:1811911779
Name:SHAH, RAJESH A (MD)
Entity type:Individual
Prefix:
First Name:RAJESH
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:PO BOX 940145
Mailing Address - Street 2:
Mailing Address - City:MAITLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32794-0145
Mailing Address - Country:US
Mailing Address - Phone:407-915-5643
Mailing Address - Fax:407-960-2602
Practice Address - Street 1:251 MAITLAND AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4914
Practice Address - Country:US
Practice Address - Phone:407-915-5643
Practice Address - Fax:407-960-2602
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96007207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME96007OtherMEDICAL LICENSE
FL014023900Medicaid
FL145XPOtherBCBS OF FL
FL014023900Medicaid