Provider Demographics
NPI:1366556771
Name:SHAH, JAYESH S (MD)
Entity type:Individual
Prefix:
First Name:JAYESH
Middle Name:S
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1426 W BUSCH BLVD STE 105
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7648
Mailing Address - Country:US
Mailing Address - Phone:813-935-0222
Mailing Address - Fax:813-877-6330
Practice Address - Street 1:1426 W BUSCH BLVD STE 105
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7648
Practice Address - Country:US
Practice Address - Phone:813-935-0222
Practice Address - Fax:813-877-6330
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME62438207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL202573OtherAMERIGROUP
205996OtherAVMED
6009848OtherGHI
FL00700OtherUNIVERSAL
FL370960400Medicaid
FLBCBSOther17903
P00477293OtherRAILROAD MEDICARE
FL00128OtherWELLCARE & HEALTHEASE
F39816Medicare UPIN
FL17903Medicare PIN