Healthcare Provider Details

I. General information

NPI: 1720013733
Provider Name (Legal Business Name): SHIRISH A. AMIN M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/30/2019
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 Number
License Number State

VIII. Authorized Official

Name: SHIRISH A AMIN
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 724-465-6650