Provider Demographics
NPI:1952715484
Name:SHAH, SHEHZAD
Entity Type:Individual
Prefix:
First Name:SHEHZAD
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3190 S STATE ROAD 7
Mailing Address - Street 2:SUITE 12B
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-5280
Mailing Address - Country:US
Mailing Address - Phone:954-961-0511
Mailing Address - Fax:954-961-0519
Practice Address - Street 1:3190 S STATE ROAD 7
Practice Address - Street 2:SUITE 12B
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-5280
Practice Address - Country:US
Practice Address - Phone:954-961-0511
Practice Address - Fax:954-961-0519
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPTA23572225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant