MEDICARE: DR. BHAVYA RAMESH SHAH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	233789	MA
2	2085R0202X	Diagnostic Radiology Physician	R3432	TX

General Provider Information

NPI Number	:	1215141171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BHAVYA RAMESH SHAH MD

Provider Business Mailing Address
First Line	:	PO BOX 845347
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-5347
Country	:	US
Telephone Number	:	214-648-7813
Fax Number	:

Provider Business Practice Location Address
First Line	:	5323 HARRY HINES BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75390-2905
Country	:	US
Telephone Number	:	214-648-7813
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/21/2022

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