Healthcare Provider Details

I. General information

NPI: 1912354267
Provider Name (Legal Business Name): REEMA SUJIT SHAH D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2016
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E 15TH ST UT AUSTIN DELL MEDICAL SCHOOL INTERNAL MEDICINE
AUSTIN TX
78701-1930
US

IV. Provider business mailing address

601 E 15TH ST UT AUSTIN DELL MEDICAL SCHOOL INTERNAL MEDICINE
AUSTIN TX
78701-1930
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-8355
  • Fax:
Mailing address:
  • Phone: 512-324-8355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberBP10056861
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS1912
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: