Provider Demographics
NPI:1962881698
Name:SHAH, NISHI MADHUSUDAN (MD)
Entity type:Individual
Prefix:
First Name:NISHI
Middle Name:MADHUSUDAN
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3815 E BELL RD STE 2500
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2151
Mailing Address - Country:US
Mailing Address - Phone:602-258-4321
Mailing Address - Fax:602-253-5917
Practice Address - Street 1:3815 E BELL RD STE 2500
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2151
Practice Address - Country:US
Practice Address - Phone:602-258-4321
Practice Address - Fax:602-253-5917
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ60122207WX0120X
FLME140126207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist