Healthcare Provider Details

I. General information

NPI: 1336526037
Provider Name (Legal Business Name): MONISHA HITESH SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 FANNIN ST MSB 3.151
HOUSTON TX
77030-1501
US

IV. Provider business mailing address

6431 FANNIN ST MSB 3.151
HOUSTON TX
77030-1501
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-5800
  • Fax: 713-500-5805
Mailing address:
  • Phone: 713-500-5800
  • Fax: 713-500-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License NumberT3382
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: