Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | Q8633 | TX |
NPI | 1164621439 |
---|---|
Provider Name | Dr. Amita Rashmikant Shah |
First Address | San Antonio, TX 78240-1641 |
Second Address | San Antonio, TX 78240-1641 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2007 |
Last Update Date | 19/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
13932514 | CAQH (01) | |
361488501 | (05) | TX |
361488502 | CSHCN (01) | TX |