Sudha V. Shah, M.D.

Primary specialty

Pediatric Adolescent Medicine PhysicianTaxonomy code 2080A0000X

License

036060895 Issued in IL

Practice address

1516 W Devon Ave
Chicago, IL 60660-1314

Phone

(773) 465-7889

Fax

(773) 465-7615

NPI assigned

Aug 5, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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": "1154736000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417966789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606601314",
            "telephone_number": "773-465-7889",
            "fax_number": "773-465-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 W DEVON AVE",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606601314",
            "telephone_number": "773-465-7889",
            "fax_number": "773-465-7615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "SUDHA",
        "middle_name": "V.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-08-05",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2080A0000X",
            "taxonomy_group": "",
            "desc": "Pediatrics, Adolescent Medicine",
            "state": "IL",
            "license": "036060895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036060895",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sima Shah, PHARM.D.
• Sneha Shah
• Sonam Shah, M.D.
• Sonam Ashish Shah, M.D.
• Sonia Shah, M.D.
• Suhrud Jitendra Shah, DMD
• Sujay Shah
• Suresh Shah, MD
• Sweta Shah, DDS
• Syed Shah, M.D.

• Pediatric Adolescent Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Pediatric Adolescent Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.