Individual
DR. ANDREA ELLEN CLARK SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
14810 OLD SAINT AUGUSTINE RD STE 106, JACKSONVILLE, FL 32258-2558
(904) 268-7701
(904) 268-9708
Mailing address
PO BOX 746638, ATLANTA, GA 30374-6638
(904) 202-2092
(904) 376-4075
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
ME91797
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008434500
—
FL
Enumeration date
09/09/2009
Last updated
11/19/2024
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