Healthcare Provider Details

I. General information

NPI: 1003090663
Provider Name (Legal Business Name): MANSI SHAH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 YOUREE DR STE 720
SHREVEPORT LA
71115-2336
US

IV. Provider business mailing address

8001 YOUREE DR STE 720
SHREVEPORT LA
71115-2336
US

V. Phone/Fax

Practice location:
  • Phone: 318-212-3833
  • Fax: 318-212-3841
Mailing address:
  • Phone: 318-212-3833
  • Fax: 318-212-3841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberPENDING
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberN1445
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number300501
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: