Healthcare Provider Details

I. General information

NPI: 1083050058
Provider Name (Legal Business Name): MAULI N SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2013
Last Update Date: 01/09/2024
Certification Date: 01/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 DEER RIDGE DR
ROUND ROCK TX
78681-5514
US

IV. Provider business mailing address

110 DEER RIDGE DR
ROUND ROCK TX
78681-5514
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-8400
  • Fax: 512-485-8593
Mailing address:
  • Phone: 512-458-8400
  • Fax: 512-485-8593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberS7336
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: