Provider Demographics
NPI:1124096391
Name:SHAH, ARCHANA (MD)
Entity type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 ALOMA AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3301
Mailing Address - Country:US
Mailing Address - Phone:321-422-3660
Mailing Address - Fax:407-644-2981
Practice Address - Street 1:2100 ALOMA AVE STE 204
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3301
Practice Address - Country:US
Practice Address - Phone:321-422-3660
Practice Address - Fax:407-644-2981
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92663207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH32667Medicare UPIN
FL16115ZMedicare ID - Type Unspecified