Basic Information
| Provider Information | |||||||||
| NPI: | 1043447360 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | ASHA | ||||||||
| MiddleName: | PATEL | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1152 ORME CIR NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303063656 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 6919 N DALE MABRY HWY STE 210 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336143972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135584900 | ||||||||
| FaxNumber: | 8135582155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2009 | ||||||||
| LastUpdateDate: | 12/23/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | 06992 | GA | N | Allopathic & Osteopathic Physicians | Dermatology | 2083P0011X | ME142105 | FL | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207N00000X | ME142105 | FL | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.