Provider Demographics
NPI:1164621439
Name:SHAH, AMITA RASHMIKANT (MD)
Entity Type:Individual
Prefix:DR
First Name:AMITA
Middle Name:RASHMIKANT
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 DOMINION DR BLDG 1
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1390
Mailing Address - Country:US
Mailing Address - Phone:210-658-3555
Mailing Address - Fax:210-362-1582
Practice Address - Street 1:4 DOMINION DR BLDG 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1390
Practice Address - Country:US
Practice Address - Phone:210-658-3555
Practice Address - Fax:210-362-1582
Is Sole Proprietor?:No
Enumeration Date:2007-07-16
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ86332086S0122X
NC1899642086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX361488502OtherCSHCN
13932514OtherCAQH
TX361488501Medicaid