Provider Demographics
NPI:1215928254
Name:SHAH, NIMISHA DARSHAK (MD)
Entity type:Individual
Prefix:
First Name:NIMISHA
Middle Name:DARSHAK
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:NIMISHA
Other - Middle Name:NARENDRA
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:602-214-6148
Mailing Address - Fax:602-214-6149
Practice Address - Street 1:21681 N 77TH AVE
Practice Address - Street 2:STE. 1410
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2132
Practice Address - Country:US
Practice Address - Phone:623-312-2265
Practice Address - Fax:623-312-2266
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34447207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ969636Medicaid
AZZ106453Medicare PIN