Healthcare Provider Details

I. General information

NPI: 1780909135
Provider Name (Legal Business Name): ANITA R. SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANITA N. PATEL MD

II. Dates (important events)

Enumeration Date: 03/29/2010
Last Update Date: 05/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N FM 548, SUITE 100
FORNEY TX
75126
US

IV. Provider business mailing address

101 N FM 548, SUITE 100
FORNEY TX
75126
US

V. Phone/Fax

Practice location:
  • Phone: 972-646-3346
  • Fax: 972-564-2079
Mailing address:
  • Phone: 972-646-3346
  • Fax: 972-564-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP4690
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: