Healthcare Provider Details

I. General information

NPI: 1912169442
Provider Name (Legal Business Name): AMY P SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1951 BISHOP LN STE 300
LOUISVILLE KY
40218-1950
US

IV. Provider business mailing address

782 THEODORE BURNETT CT APT 5
LOUISVILLE KY
40217-2930
US

V. Phone/Fax

Practice location:
  • Phone: 502-446-5610
  • Fax: 502-446-5619
Mailing address:
  • Phone: 502-435-7620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number14368
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35.097850
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number01070244A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number35097850
License Number StateOH
# 5
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number44884
License Number StateKY
# 6
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number44884
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: