Healthcare Provider Details

I. General information

NPI: 1215387246
Provider Name (Legal Business Name): DIMAL D SHAH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 09/27/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 SHERWOOD AVE
RICHMOND VA
23220-1210
US

IV. Provider business mailing address

1308 SHERWOOD AVE
RICHMOND VA
23220-1210
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-3137
  • Fax: 804-828-9493
Mailing address:
  • Phone: 804-828-3137
  • Fax: 804-828-9493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number0101269739
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: