Basic Information
| Provider Information | |||||||||
| NPI: | 1770552390 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | SURESHCHANDRA | ||||||||
| MiddleName: | O | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1501 PRESIDENTIAL WAY | ||||||||
| Address2: | 12 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334011800 | ||||||||
| 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: | 03/16/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | ME31288 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
No ID Information.