Provider Demographics
NPI:1891010476
Name:SHAH, NISHAN ANILKUMAR (MD)
Entity type:Individual
Prefix:
First Name:NISHAN
Middle Name:ANILKUMAR
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 1:1313 VINETREE DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-2091
Mailing Address - Country:US
Mailing Address - Phone:813-480-3563
Mailing Address - Fax:
Practice Address - Street 1:2810 MANATEE AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-1828
Practice Address - Country:US
Practice Address - Phone:941-226-0206
Practice Address - Fax:941-900-1043
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL123001207P00000X
CT051833207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine