Provider Demographics
NPI:1366671265
Name:SHAH, DISHA (MD)
Entity Type:Individual
Prefix:
First Name:DISHA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-361-6055
Mailing Address - Fax:502-361-6087
Practice Address - Street 1:6400 DUTCHMANS PKWY
Practice Address - Street 2:SUITE 175
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3340
Practice Address - Country:US
Practice Address - Phone:502-361-6055
Practice Address - Fax:502-361-6087
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2014-02-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD4393342084N0600X
KY463052084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical Neurophysiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100250160Medicaid
KYP01253581OtherRAILROAD MEDICARE
KYP01253581OtherRAILROAD MEDICARE