Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | ME96817 | FL |
NPI | 1083617229 |
---|---|
Provider Name | Ajit Shah |
First Address | Orlando, FL 32832-5913 |
Second Address | Orlando, FL 32832-5913 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 28/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100084540 | (05) | IN |
C24778 | (02) | IN |