Provider Demographics
NPI:1871782268
Name:SHAH, CHINTAN B (MD)
Entity type:Individual
Prefix:DR
First Name:CHINTAN
Middle Name:B
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHINTAN
Other - Middle Name:B
Other - Last Name:SHAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2215 NEBRASKA AVE
Mailing Address - Street 2:STE 2B
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4864
Mailing Address - Country:US
Mailing Address - Phone:772-302-3767
Mailing Address - Fax:888-436-7197
Practice Address - Street 1:2215 NEBRASKA AVE
Practice Address - Street 2:STE 2B
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4864
Practice Address - Country:US
Practice Address - Phone:772-464-4050
Practice Address - Fax:772-464-4421
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME107058207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine