Provider Demographics
NPI:1588088033
Name:SHAH, MONA (MD)
Entity type:Individual
Prefix:DR
First Name:MONA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONA
Other - Middle Name:
Other - Last Name:BHATT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:205 DR M L KING ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-3109
Mailing Address - Country:US
Mailing Address - Phone:727-824-6900
Mailing Address - Fax:
Practice Address - Street 1:205 DR M L KING ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-3109
Practice Address - Country:US
Practice Address - Phone:727-824-6900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-04
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1163062083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine