MEDICARE: DEEPAL SHAH M.D.

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	2084E0001X	Epilepsy Physician	S3585	TX
2	2084N0400X	Neurology Physician	S3585	TX

General Provider Information

NPI Number	:	1447566740
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEEPAL SHAH M.D.

Provider Business Mailing Address
First Line	:	PO BOX 58538
Second Line	:
City	:	WEBSTER
State	:	TX
Zip	:	77598-8538
Country	:	US
Telephone Number	:	281-915-3860
Fax Number	:	346-843-1001

Provider Business Practice Location Address
First Line	:	14100 SOUTHWEST FWY STE 400
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3465
Country	:	US
Telephone Number	:	281-915-3860
Fax Number	:	346-843-1001

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

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	10/18/2024

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