Provider Demographics
NPI:1528355799
Name:SHAH, SANKET U (MD)
Entity type:Individual
Prefix:DR
First Name:SANKET
Middle Name:U
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1109 S PARK VICTORIA DR
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-6942
Mailing Address - Country:US
Mailing Address - Phone:714-732-1417
Mailing Address - Fax:
Practice Address - Street 1:1109 S PARK VICTORIA DR
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-6942
Practice Address - Country:US
Practice Address - Phone:714-732-1417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA139153207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN11017085AOtherMEDICAL RESIDENCY PERMIT LICENSE