Healthcare Provider Details

I. General information

NPI: 1982919585
Provider Name (Legal Business Name): DISHA R. SHAH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2010
Last Update Date: 02/18/2026
Certification Date: 02/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 TIDEWATER DR STE 19
NORFOLK VA
23505-3700
US

IV. Provider business mailing address

7525 TIDEWATER DR STE 19
NORFOLK VA
23505-3700
US

V. Phone/Fax

Practice location:
  • Phone: 757-330-0150
  • Fax: 877-487-3044
Mailing address:
  • Phone: 757-330-0150
  • Fax: 877-487-3044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number50665
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: