Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | ME48069 | FL |
Y | 207RX0202X | Medical Oncology | ME48069 | FL |
NPI | 1407850449 |
---|---|
Provider Name | Amit Indravadan Shah |
First Address | Fort Myers, FL 33916-2216 |
Second Address | Sebring, FL 33870-1204 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2005 |
Last Update Date | 20/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
045758200 | (05) | FL |
D83969 | (02) | FL |