Provider Demographics
NPI:1154362770
Name:SHAH, SANDEEP N (MD)
Entity type:Individual
Prefix:DR
First Name:SANDEEP
Middle Name:N
Last Name:SHAH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 410108
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-0108
Mailing Address - Country:US
Mailing Address - Phone:405-607-6699
Mailing Address - Fax:405-607-6685
Practice Address - Street 1:1851 S KELLY AVE STE A
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3929
Practice Address - Country:US
Practice Address - Phone:405-607-6699
Practice Address - Fax:405-607-6685
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK22912207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200198330AMedicaid
OK200198330AMedicaid
WII57063Medicare UPIN
OKP00698367Medicare PIN