Healthcare Provider Details

I. General information

NPI: 1538881131
Provider Name (Legal Business Name): SARAH SHAH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2022
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25214 BOROUGH PARK DR
SPRING TX
77380-3519
US

IV. Provider business mailing address

25214 BOROUGH PARK DR
SPRING TX
77380-3519
US

V. Phone/Fax

Practice location:
  • Phone: 281-292-7770
  • Fax:
Mailing address:
  • Phone: 281-292-7770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberPA15946
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15946
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: