Provider Demographics
NPI:1578700340
Name:SHAH, NIHITA PRAVIN
Entity Type:Individual
Prefix:
First Name:NIHITA
Middle Name:PRAVIN
Last Name:SHAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:927 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77506-1430
Mailing Address - Country:US
Mailing Address - Phone:713-982-5927
Mailing Address - Fax:
Practice Address - Street 1:3701 KIRBY DR STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77098-3926
Practice Address - Country:US
Practice Address - Phone:713-867-8281
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10030091207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L17035Medicare PIN