Provider Demographics
NPI:1518124452
Name:SHAH, MEHA M (MD)
Entity Type:Individual
Prefix:
First Name:MEHA
Middle Name:M
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 975341
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75397-5341
Mailing Address - Country:US
Mailing Address - Phone:972-791-1224
Mailing Address - Fax:
Practice Address - Street 1:1105 CENTRAL EXPY N
Practice Address - Street 2:SUITE 235
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-6103
Practice Address - Country:US
Practice Address - Phone:972-747-6042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-19
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116017559208M00000X
TXN7348207R00000X
VA0101251693208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX350022YLP1OtherSAIMS TRAVIS MEDICARE
TX350022YLP2OtherSAIMS ROT MEDICARE
TX350022YLP1OtherSAIMS TRAVIS MEDICARE