Provider Demographics
NPI:1053402719
Name:SHAH, GIRA S (MD, PA)
Entity type:Individual
Prefix:DR
First Name:GIRA
Middle Name:S
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 S SEMINOLE AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4737
Mailing Address - Country:US
Mailing Address - Phone:352-726-7800
Mailing Address - Fax:352-726-8300
Practice Address - Street 1:203 S SEMINOLE AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4737
Practice Address - Country:US
Practice Address - Phone:352-726-7800
Practice Address - Fax:352-726-8300
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME71583207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268959600Medicaid
FL32187OtherBLUE CROSS AND BLUE SHIEL
FLP00061384OtherRAIL ROAD MEDICARE
FLP00061384OtherRAIL ROAD MEDICARE
FL34753Medicare UPIN