Provider Demographics
NPI:1548070469
Name:SHAH, HARSH
Entity type:Individual
Prefix:MR
First Name:HARSH
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 QUEENSBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-6454
Mailing Address - Country:US
Mailing Address - Phone:909-503-4063
Mailing Address - Fax:
Practice Address - Street 1:602 QUEENSBRIDGE DR
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-6454
Practice Address - Country:US
Practice Address - Phone:909-503-4063
Practice Address - Fax:909-503-4063
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-13
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies