Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | L0586 | TX |
Y | 207PE0004X | Emergency Medical Services | L0586 | TX |
NPI | 1184689937 |
---|---|
Provider Name | Ms. Deepa M Shah |
First Address | Austin, TX 78733-5719 |
Second Address | Austin, TX 78701-1930 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 10/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
030217602 | (05) | TX |
H49940 | (02) | TX |