Healthcare Provider Details

I. General information

NPI: 1144024092
Provider Name (Legal Business Name): SHALIN SANDEEP SHAH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2025
Last Update Date: 04/02/2025
Certification Date: 04/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6560 FANNIN ST STE 944
HOUSTON TX
77030-2706
US

IV. Provider business mailing address

639 POINT LOMA DR
FRISCO TX
75036-8893
US

V. Phone/Fax

Practice location:
  • Phone: 713-441-3800
  • Fax:
Mailing address:
  • Phone: 214-402-0003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: