Basic Information
| Provider Information | |||||||||
| NPI: | 1922000751 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | NEENAD | ||||||||
| MiddleName: | MAHENDRA | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 746654 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303746654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042022092 | ||||||||
| FaxNumber: | 9043937603 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 PALM AVE | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 322078432 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9042027300 | ||||||||
| FaxNumber: | 9042027433 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2005 | ||||||||
| LastUpdateDate: | 04/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | ME90197 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1098377 | 01 | FL | WELLCARE | OTHER | P01451923 | 01 | FL | RR MEDICARE | OTHER | 269981800 | 05 | FL | MEDICAID | 299017 | 01 | FL | AVMED | OTHER | P015696540 | 01 | FL | RR MEDICARE | OTHER | 1115825 | 01 | FL | CARE PLUS | OTHER | 1193468 | 01 | FL | WELLCARE | OTHER | 3625970 | 01 | FL | CIGNA | OTHER | 44111 | 01 | FL | BCBS | OTHER | 7633639 | 01 | FL | AETNA | OTHER |