Individual
DR. SHIVAM SHAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3801 E HIGHWAY 98, PORT ST JOE, FL 32456-5318
(850) 229-5600
Mailing address
1601 CUMMINS DR STE D, MODESTO, CA 95358-6411
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
MD-55359
IA
207P00000X
Emergency Medicine Physician
Primary
ME179832
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/29/2021
Last updated
05/12/2026
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