Provider Demographics
NPI:1700841251
Name:BADHIWALA, SHAMJI P (MD)
Entity Type:Individual
Prefix:
First Name:SHAMJI
Middle Name:P
Last Name:BADHIWALA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:716 AUBURN CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TX
Mailing Address - Zip Code:76227-7924
Mailing Address - Country:US
Mailing Address - Phone:214-704-7328
Mailing Address - Fax:972-852-9016
Practice Address - Street 1:110 S 12TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1810
Practice Address - Country:US
Practice Address - Phone:254-752-3451
Practice Address - Fax:972-852-9016
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXH34402084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB21053Medicare UPIN