Provider Demographics
NPI:1154485423
Name:SHAH, SATISH J (MD)
Entity type:Individual
Prefix:DR
First Name:SATISH
Middle Name:J
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SATISH
Other - Middle Name:J
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD, FICS, PA
Mailing Address - Street 1:601 EAST SAMPLE RD
Mailing Address - Street 2:STE 109
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-785-6335
Mailing Address - Fax:954-785-1520
Practice Address - Street 1:601 EAST SAMPLE RD
Practice Address - Street 2:STE 109
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-785-6335
Practice Address - Fax:954-785-1520
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0026347207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
48867Medicare ID - Type Unspecified
E42520Medicare UPIN