Provider Demographics
NPI:1316248305
Name:MEHTA, SHIVANI UPENDRA (MD)
Entity type:Individual
Prefix:DR
First Name:SHIVANI
Middle Name:UPENDRA
Last Name:MEHTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:12217 SITTING BULL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-7891
Mailing Address - Country:US
Mailing Address - Phone:801-615-1796
Mailing Address - Fax:
Practice Address - Street 1:2101 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3346
Practice Address - Country:US
Practice Address - Phone:915-577-7888
Practice Address - Fax:915-577-7690
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN79472084N0400X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology