Provider Demographics
NPI:1477557437
Name:SHAH, RINOO VASANT (MD)
Entity Type:Individual
Prefix:
First Name:RINOO
Middle Name:VASANT
Last Name:SHAH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 W ROYAL LN
Mailing Address - Street 2:STE 230
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-3901
Mailing Address - Country:US
Mailing Address - Phone:570-888-5858
Mailing Address - Fax:
Practice Address - Street 1:3900 JUNIUS ST STE 705
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1627
Practice Address - Country:US
Practice Address - Phone:469-800-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-08
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA205878-1208VP0014X, 207LP2900X
TXL4708208VP0014X, 208100000X
PAMD428582207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1017923580002Medicaid
NY02817114Medicaid
NYAA0598OtherNY MEDICARE GROUP
NYCC8362OtherNY RR MEDICARE GROUP
PAGU039832OtherPA MEDICARE GROUP
PA106676N8ZMedicare PIN
PA1017923580002Medicaid
NYRB2569Medicare PIN