Provider Demographics
NPI:1124098249
Name:SHAH, SHALIN (MD)
Entity type:Individual
Prefix:
First Name:SHALIN
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4612 N HABANA AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7101
Mailing Address - Country:US
Mailing Address - Phone:813-875-9000
Mailing Address - Fax:813-874-3278
Practice Address - Street 1:4612 N HABANA AVE FL 2
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7101
Practice Address - Country:US
Practice Address - Phone:813-875-9000
Practice Address - Fax:813-874-3278
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060740207RC0000X, 207RC0001X
FLME97804207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277671500Medicaid
FL277671500Medicaid
FLI131457Medicare UPIN
IN058490NNNMedicare ID - Type Unspecified