Provider Demographics
NPI:1881498921
Name:SANJIV SHAH MD LLC
Entity type:Organization
Organization Name:SANJIV SHAH MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANJIV
Authorized Official - Middle Name:ISHVERLAL
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-565-7006
Mailing Address - Street 1:5915 W GULF TO LAKE HWY
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34429-7565
Mailing Address - Country:US
Mailing Address - Phone:352-565-7006
Mailing Address - Fax:786-220-8715
Practice Address - Street 1:5915 W GULF TO LAKE HWY
Practice Address - Street 2:
Practice Address - City:CRYSTAL RIVER
Practice Address - State:FL
Practice Address - Zip Code:34429-7565
Practice Address - Country:US
Practice Address - Phone:352-565-7006
Practice Address - Fax:786-220-8715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty