Provider Demographics
NPI:1710145123
Name:SHAH, PRANAV (MD)
Entity type:Individual
Prefix:
First Name:PRANAV
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Other - Middle Name:
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Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-9710
Mailing Address - Fax:239-343-9715
Practice Address - Street 1:16271 BASS RD FL 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3616
Practice Address - Country:US
Practice Address - Phone:239-343-9710
Practice Address - Fax:239-343-4178
Is Sole Proprietor?:No
Enumeration Date:2008-06-02
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME120442207RI0200X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL013360500Medicaid