Provider Demographics
NPI:1427155191
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:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 PARK ST N STE 1017
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2236
Mailing Address - Country:US
Mailing Address - Phone:727-344-6570
Mailing Address - Fax:727-384-4388
Practice Address - Street 1:3000 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-2635
Practice Address - Country:US
Practice Address - Phone:727-344-6569
Practice Address - Fax:727-384-4388
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL624392085R0001X
FLME624392085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLKY325OtherMEDICARE
FL021323000Medicaid
KY326OtherMEDICARE
KY64295637Medicaid
KYP400029716Medicare PIN
E26783Medicare UPIN
000000044249OtherBCBS PROVIDER NUMBER