MEDICARE: VANDANA MRUGESH 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	207R00000X	Internal Medicine Physician	P8537	TX

General Provider Information

NPI Number	:	1285871681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VANDANA MRUGESH SHAH MD

Provider Business Mailing Address
First Line	:	2001 N JEFFERSON AVE STE 204
Second Line	:
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-2392
Country	:	US
Telephone Number	:	903-577-7003
Fax Number	:	903-577-3933

Provider Business Practice Location Address
First Line	:	2001 N JEFFERSON AVE
Second Line	:	SUITE 204
City	:	MT PLEASANT
State	:	TX
Zip	:	75455-2338
Country	:	US
Telephone Number	:	903-577-7003
Fax Number	:	903-577-3933

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

Provider Enumeration Date	:	01/07/2009
Last Update Date	:	11/05/2025

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