Provider Demographics
NPI:1144424722
Name:SHAH, SWATI M (MBBS)
Entity type:Individual
Prefix:DR
First Name:SWATI
Middle Name:M
Last Name:SHAH
Suffix:
Gender:F
Credentials:MBBS
Other - Prefix:
Other - First Name:SWATI
Other - Middle Name:RASIKLAL
Other - Last Name:MODI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2255 GLADES RD STE 228W
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7391
Mailing Address - Country:US
Mailing Address - Phone:904-517-8222
Mailing Address - Fax:
Practice Address - Street 1:9765 SAN JOSE BLVD STE 103
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-5467
Practice Address - Country:US
Practice Address - Phone:904-517-8222
Practice Address - Fax:904-517-1222
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98418207RR0500X, 207RR0500X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01321209OtherRAILROAD MEDICARE
GA163413836AMedicaid
FL2784947-00Medicaid
FL2784947-00Medicaid
FLAE424ZMedicare PIN
944711999OtherMYUTMB 944711999-COMMERCIAL NUMBER
GA163413836AMedicaid
FLAE424WMedicare PIN