Provider Demographics
NPI:1275504474
Name:SHAH, AMISHI Y (MD)
Entity Type:Individual
Prefix:DR
First Name:AMISHI
Middle Name:Y
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:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-1246
Mailing Address - Fax:704-384-1249
Practice Address - Street 1:200 HAWTHORNE LN
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2515
Practice Address - Country:US
Practice Address - Phone:704-384-9414
Practice Address - Fax:704-384-5735
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC218712084P0800X
NC2008-011452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89066TTMedicaid
SC218712Medicaid
SCC7068OtherMEDCOST
SCP00046884Medicare PIN
NC2073973Medicare PIN
SCC7068OtherMEDCOST
SCH84947Medicare PIN