Healthcare Provider Details

I. General information

NPI: 1679936959
Provider Name (Legal Business Name): SAGAR AMIT SHAH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2016
Last Update Date: 03/11/2024
Certification Date: 03/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4212 W CONGRESS ST STE 3100
LAFAYETTE LA
70506-6771
US

IV. Provider business mailing address

4212 W CONGRESS ST STE 3100
LAFAYETTE LA
70506-6771
US

V. Phone/Fax

Practice location:
  • Phone: 804-704-1079
  • Fax:
Mailing address:
  • Phone: 337-703-3202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number333208
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number2024-00367
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: