Healthcare Provider Details

I. General information

NPI: 1124400494
Provider Name (Legal Business Name): DHVANI SHANGHVI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2015
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6701 FANNIN ST
HOUSTON TX
77030-2608
US

IV. Provider business mailing address

6701 FANNIN ST
HOUSTON TX
77030-2608
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-6522
  • Fax: 832-825-0350
Mailing address:
  • Phone: 832-824-6522
  • Fax: 832-825-0350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2015019340
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR8272
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: