Provider Demographics
NPI:1972793917
Name:SHAH, SAYANA R (MD)
Entity type:Individual
Prefix:DR
First Name:SAYANA
Middle Name:R
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1043 ELM AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3244
Mailing Address - Country:US
Mailing Address - Phone:562-491-9890
Mailing Address - Fax:562-491-9091
Practice Address - Street 1:1043 ELM AVE STE 110
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3244
Practice Address - Country:US
Practice Address - Phone:562-491-9890
Practice Address - Fax:562-491-9091
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA1191002085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7696936OtherCIGNA
CAP01090150OtherRAILROAD MEDICARE
CA1972793917Medicaid
CAP01090150OtherRAILROAD MCR
CA9893903OtherAETNA
CA00A119100Z63OtherCALOPTIMA
CA1972793917Medicaid