Provider Demographics
NPI:1639242266
Name:SHAH, SANDY N (DO)
Entity Type:Individual
Prefix:
First Name:SANDY
Middle Name:N
Last Name:SHAH
Suffix:
Gender:F
Credentials:DO
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 62837
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77205-2801
Mailing Address - Country:US
Mailing Address - Phone:281-257-2020
Mailing Address - Fax:
Practice Address - Street 1:5501 LOUETTA RD
Practice Address - Street 2:SUITE D
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-7868
Practice Address - Country:US
Practice Address - Phone:281-257-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0588207R00000X, 207RC0000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C9084Medicare PIN
TXH55171Medicare UPIN