Provider Demographics
NPI:1316259864
Name:SHAH, NISHIT SHASHIKANT (MD)
Entity type:Individual
Prefix:
First Name:NISHIT
Middle Name:SHASHIKANT
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10435 GREENBOUGH DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5000
Mailing Address - Country:US
Mailing Address - Phone:281-261-0182
Mailing Address - Fax:281-969-1764
Practice Address - Street 1:10435 GREENBOUGH DR
Practice Address - Street 2:SUITE 300
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5000
Practice Address - Country:US
Practice Address - Phone:281-261-0182
Practice Address - Fax:281-969-1764
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-12
Last Update Date:2014-01-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXP7349208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP7349OtherTEXAS MEDICAL LICENCE