Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 63664 | CA |
Y | 1223G0001X | General Practice | 63664 | TX |
Y | 213EG0000X | General Practice | 63664 | TX |
NPI | 1003224056 |
---|---|
Provider Name | Dr. Shamik Mahendra Shastri |
First Address | Plano, TX 75074-8393 |
Second Address | Flower Mound, TX 75028-5636 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/07/2014 |
Last Update Date | 17/03/2018 |