Healthcare Provider Details

I. General information

NPI: 1114903994
Provider Name (Legal Business Name): SHIRISH A AMIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 WAYNE AVE 119 PROFESSIONAL CENTER, SUITE 301
INDIANA PA
15701-3501
US

IV. Provider business mailing address

1265 WAYNE AVE 119 PROFESSIONAL CENTER, SUITE 301
INDIANA PA
15701-3501
US

V. Phone/Fax

Practice location:
  • Phone: 724-465-6650
  • Fax: 724-357-9281
Mailing address:
  • Phone: 724-465-6650
  • Fax: 724-357-9281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD050640L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207RI0008X
TaxonomyHepatology Physician
License NumberMD050640L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: