=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881010049
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MANISHA SHAH MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2014
-----------------------------------------------------
Last Update Date | 07/14/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3537 S INTERSTATE 35 E STE 220
-----------------------------------------------------
City | DENTON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76210-6800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 940-765-8484
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6717 CLEAR SPRINGS CIR
-----------------------------------------------------
City | GARLAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75044-2826
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MANISHA SHAH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 940-765-8484
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------