Provider Demographics
NPI:1679936959
Name:SHAH, SAGAR AMIT (MD)
Entity Type:Individual
Prefix:
First Name:SAGAR
Middle Name:AMIT
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 1:4212 W CONGRESS ST STE 3100
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70506-6771
Mailing Address - Country:US
Mailing Address - Phone:337-703-3202
Mailing Address - Fax:
Practice Address - Street 1:4212 W CONGRESS ST STE 3100
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70506-6771
Practice Address - Country:US
Practice Address - Phone:804-704-1079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-03
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA333208207XS0106X
NC2024-00367207XS0106X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program