Provider Demographics
NPI:1104923176
Name:SHAH, SHASHIKANT P (MD)
Entity type:Individual
Prefix:MR
First Name:SHASHIKANT
Middle Name:P
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:9700 GARFIELD BLVD
Mailing Address - Street 2:#103
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44125
Mailing Address - Country:US
Mailing Address - Phone:216-641-0600
Mailing Address - Fax:216-641-0628
Practice Address - Street 1:9700 GARFIELD BLVD
Practice Address - Street 2:#103
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125
Practice Address - Country:US
Practice Address - Phone:216-641-0600
Practice Address - Fax:216-641-0628
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH034329208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH735722OtherBUCKEYE
OH000000129523OtherANTHEM BLUE SHIELD
OH0203694Medicaid
OH202883OtherWELLCARE
OHT03520OtherSUMMACARE
OH000000129523OtherUNICARE