Provider Demographics
NPI:1578763397
Name:STEPHANIE SHAH, MD, PA
Entity Type:Organization
Organization Name:STEPHANIE SHAH, MD, PA
Other - Org Name:PAIN MANAGEMENT ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:HUGGHINS
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-403-0682
Mailing Address - Street 1:PO BOX 941010
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75094-1010
Mailing Address - Country:US
Mailing Address - Phone:214-403-0682
Mailing Address - Fax:
Practice Address - Street 1:6957 W PLANO PKWY STE 2000
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-1623
Practice Address - Country:US
Practice Address - Phone:214-403-0682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6873207L00000X
TXL7708207L00000X
TXG6715207L00000X
TXN1568207L00000X
TXL4574207L00000X
TXM4242207L00000X
TXL6175207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Multi-Specialty