Provider Demographics
NPI:1205095478
Name:SHAH, SHAILY (DO)
Entity type:Individual
Prefix:
First Name:SHAILY
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1147 ABBEYS WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5958
Mailing Address - Country:US
Mailing Address - Phone:914-466-4428
Mailing Address - Fax:
Practice Address - Street 1:2727 W MLK BLVD STE 450
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-875-8453
Practice Address - Fax:813-377-1390
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12416207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine