Basic Information
| Provider Information | |||||||||
| NPI: | 1114066685 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SHAH.M.D.P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 PRESIDENTIAL WAY | ||||||||
| Address2: | #12 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334011852 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614719484 | ||||||||
| FaxNumber: | 5614719555 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 PRESIDENTIAL WAY | ||||||||
| Address2: | #12 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334011800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5614719484 | ||||||||
| FaxNumber: | 5614719555 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SHAH | ||||||||
| AuthorizedOfficialFirstName: | MALVIKA | ||||||||
| AuthorizedOfficialMiddleName: | SURESH | ||||||||
| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5614719484 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.