Provider Demographics
NPI:1871580555
Name:SHAH, SHIRLEY
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9600 PARKSOUTH CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6424
Mailing Address - Country:US
Mailing Address - Phone:877-453-4566
Mailing Address - Fax:866-537-0877
Practice Address - Street 1:9600 PARKSOUTH CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6424
Practice Address - Country:US
Practice Address - Phone:877-453-4566
Practice Address - Fax:866-537-0877
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS30294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist