Provider Demographics
NPI:1215012000
Name:SHAH, MANISHA JAY (MD)
Entity type:Individual
Prefix:DR
First Name:MANISHA
Middle Name:JAY
Last Name:SHAH
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6717 CLEAR SPRINGS CIR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75044-2826
Mailing Address - Country:US
Mailing Address - Phone:940-765-8484
Mailing Address - Fax:940-220-7527
Practice Address - Street 1:3537 S I 35 E STE 220
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6813
Practice Address - Country:US
Practice Address - Phone:972-765-8484
Practice Address - Fax:940-220-7527
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8767207RC0000X
FLME169276207RC0000X
VA0101271026207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease