Priyamvada N Shah, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01029161A Issued in IN

Practice address

8911 Liberty Mills Rd
Fort Wayne, IN 46804-6311

Phone

(260) 373-9465

Fax

(260) 266-9406

NPI assigned

Dec 27, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Priya N Shah Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1135641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469664000000",
    "number": "1174500664",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8911 LIBERTY MILLS RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046311",
            "telephone_number": "260-373-9465",
            "fax_number": "260-266-9406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8911 LIBERTY MILLS RD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468046311",
            "telephone_number": "260-373-9465",
            "fax_number": "260-266-9406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "PRIYAMVADA",
        "middle_name": "N",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-12-27",
        "last_updated": "2016-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01029161A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000111784",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "0000002003211",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100051620",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIANS HEALTH PLAN",
            "identifier": "1845",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE DMEPOS",
            "identifier": "3937240003",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4052315",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "080130031",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PRIYA",
            "last_name": "SHAH",
            "middle_name": "N",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jennifer Shaffer
• Julie N. Shaffer, NP
• Noel Shafi, MS
• Shah Home Care LLC
• Bhupendra K Shah, M.D.
• Rishabh Shah, MD
• Sailendra Kumar Shah
• Sargam Shah, RPT
• Swapnil Shah
• Fowad Shahzad, MD

• Family Medicine Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Family Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.