Provider Demographics
NPI:1538712526
Name:SHAH, DEVKI SHAILESH (PA-C)
Entity type:Individual
Prefix:
First Name:DEVKI
Middle Name:SHAILESH
Last Name:SHAH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:DEVKI
Other - Middle Name:SHAILESH
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:963 2ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-1384
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11405 PENNSYLVANIA ST STE 104
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6905
Practice Address - Country:US
Practice Address - Phone:317-912-1616
Practice Address - Fax:833-449-4351
Is Sole Proprietor?:No
Enumeration Date:2019-07-19
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN10003142A363A00000X
NC0010-13399363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant