Provider Demographics
NPI:1386694842
Name:SHAH, AMIT R (MD)
Entity type:Individual
Prefix:DR
First Name:AMIT
Middle Name:R
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:12201 FAIRWAY WOODS CT
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:23836-8613
Mailing Address - Country:US
Mailing Address - Phone:804-530-7649
Mailing Address - Fax:
Practice Address - Street 1:12201 FAIRWAY WOODS CT
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23836-8613
Practice Address - Country:US
Practice Address - Phone:804-530-7649
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010480922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry