Organization
DOC AESTHETICS.LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHINTAN SHAH MD (PROVIDER)
(772) 302-3767
Entity
Organization
Contact information
Practice address
2215 NEBRASKA AVE, STE 2B, FORT PIERCE, FL 34950-4867
(772) 302-3767
Mailing address
2215 NEBRASKA AVE, STE 2B, FORT PIERCE, FL 34950
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
006739300
—
FL
Enumeration date
10/23/2024
Last updated
10/23/2024
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