Basic Information
| Provider Information | |||||||||
| NPI: | 1427155191 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | SATISH | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 PARK ST N STE 1017 | ||||||||
| Address2: | |||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337092236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273446570 | ||||||||
| FaxNumber: | 7273844388 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 US HIGHWAY 19 | ||||||||
| Address2: | |||||||||
| City: | HOLIDAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346912635 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273446569 | ||||||||
| FaxNumber: | 7273844388 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/17/2006 | ||||||||
| LastUpdateDate: | 01/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 62439 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | 2085R0001X | ME62439 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | KY325 | 01 | FL | MEDICARE | OTHER | 021323000 | 05 | FL | MEDICAID | KY326 | 01 | MEDICARE | OTHER |