Provider Demographics
NPI:1043657042
Name:SHAH, NEEL AMAR (MD)
Entity type:Individual
Prefix:DR
First Name:NEEL
Middle Name:AMAR
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W BROADWAY APT 5166
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-9443
Mailing Address - Country:US
Mailing Address - Phone:310-418-9359
Mailing Address - Fax:
Practice Address - Street 1:1050 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3321
Practice Address - Country:US
Practice Address - Phone:562-491-9761
Practice Address - Fax:562-491-9264
Is Sole Proprietor?:No
Enumeration Date:2013-05-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP20049759207P00000X
TXBP10046925208600000X
CA148775207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA148775OtherMEDICAL BOARD OF CALIFORNIA STATE LICENSE
FS6749292OtherDEA