Provider Demographics
NPI:1396240925
Name:SHAH, BEENA MANISH (MD)
Entity type:Individual
Prefix:DR
First Name:BEENA
Middle Name:MANISH
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:100 SWEETBRIAR DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-3008
Mailing Address - Country:US
Mailing Address - Phone:979-732-5771
Mailing Address - Fax:979-732-6922
Practice Address - Street 1:100 SWEETBRIAR DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-3008
Practice Address - Country:US
Practice Address - Phone:979-732-5771
Practice Address - Fax:979-732-6922
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-26
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXU3010207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program