Provider Demographics
NPI:1912909706
Name:SHAH, PARAS R (MD)
Entity Type:Individual
Prefix:DR
First Name:PARAS
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:15708 POMERADO RD
Mailing Address - Street 2:SUITE N202
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2066
Mailing Address - Country:US
Mailing Address - Phone:858-485-5600
Mailing Address - Fax:858-485-5692
Practice Address - Street 1:15708 POMERADO RD
Practice Address - Street 2:SUITE N202
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2066
Practice Address - Country:US
Practice Address - Phone:858-485-5600
Practice Address - Fax:858-485-5692
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109175174400000X
CAA100573207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA100573OtherCA MEDICAL LICENSE
IL036109175OtherM.D. LICENSE
CAA100573OtherCA MEDICAL LICENSE