Provider Demographics
NPI:1396871505
Name:VIPUL R. SHAH MD PA
Entity type:Organization
Organization Name:VIPUL R. SHAH MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VIPUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-579-0313
Mailing Address - Street 1:PO BOX 48947
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33646-0125
Mailing Address - Country:US
Mailing Address - Phone:813-579-0313
Mailing Address - Fax:902-460-6313
Practice Address - Street 1:10311 CROSS CREEK BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647-2989
Practice Address - Country:US
Practice Address - Phone:813-994-7670
Practice Address - Fax:813-994-7640
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-24
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0077541207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL71646Medicare ID - Type Unspecified