Andrea Ellen Clark Shah, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

ME91797 Issued in FL

Practice address

14810 Old Saint Augustine Rd Ste 106
Jacksonville, FL 32258-2558

Phone

(904) 268-7701

Fax

(904) 268-9708

NPI assigned

Sep 9, 2009

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: ashah28504@baptisthealthsystemjacksonville.direct-ci.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Baptist Primary Care Inc

  • Pediatrics Physician
  • Jacksonville, FL
  • NPI 1356677819
  NPD (past)
• Baptist Primary Care Inc

  • Family Medicine Physician
  • Jacksonville, FL
  • NPI 1508817529

  Pediatrics

  NPD (past)

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

{
    "created_epoch": "1252454400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1487987491",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 746638",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303746638",
            "telephone_number": "904-202-2092",
            "fax_number": "904-376-4075"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14810 OLD SAINT AUGUSTINE RD STE 106",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322582558",
            "telephone_number": "904-268-7701",
            "fax_number": "904-268-9708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAH",
        "first_name": "ANDREA",
        "middle_name": "ELLEN CLARK",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-09-09",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "FL",
            "license": "ME91797",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008434500",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Erich Ernest Shafer, D.C.0
• Amanda Lea Shaffer, PMHNP-BC, MSN, RN
• Gayle Denise Shaffer, D.M.D.
• Kara J Shaffer, PA-C
• Anjali Shah Patel, OD
• Antra Jignesh Shah
• Atif A Shah, MD
• Atul Mukutbhai Shah, MD
• Bharat R Shah I, DDS
• Dhaval Yogeshkumar Shah, DMD

• Pediatrics Physician in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Pediatrics Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2024; 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.