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General NPI Number Information
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NPI Number | 1205360203
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Entity Type | Organization
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Legal Business Name | JAYDEEP S. SHAH, M.D. PLLC
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Dates
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Enumeration Date | 04/17/2017
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 602 BENTLEY MNR
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City | SHAVANO PARK
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State | TX
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Zip | 78249-2079
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Country | US
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Telephone | 210-387-7693
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Fax | 210-481-3793
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Provider Business Mailing Address
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Address Line | 602 BENTLEY MNR
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City | SHAVANO PARK
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State | TX
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Zip | 78249-2079
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Country | US
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Telephone | 210-387-7693
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Fax | 210-481-3793
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. JAYDEEP SHAH
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Credential | M.D.
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Telephone | 210-387-7693
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | L0930
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License Number State | TX
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