Provider Demographics
NPI:1043766702
Name:SHAH, HARDIK (MD, MPH)
Entity type:Individual
Prefix:
First Name:HARDIK
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:HARDIKKUMAR
Other - Middle Name:MUKESHBHAI
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MPH
Mailing Address - Street 1:4800 BELFORT RD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-6004
Mailing Address - Country:US
Mailing Address - Phone:904-398-7205
Mailing Address - Fax:
Practice Address - Street 1:3635 CLYDE MORRIS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-2349
Practice Address - Country:US
Practice Address - Phone:386-788-1242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME163340207RG0100X
PAMD481023207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology