Provider Demographics
NPI:1760474134
Name:SHAH, SHAHZAD ISLAM (MD)
Entity Type:Individual
Prefix:
First Name:SHAHZAD
Middle Name:ISLAM
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 1:25214 BOROUGH PARK DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3519
Mailing Address - Country:US
Mailing Address - Phone:281-296-7770
Mailing Address - Fax:281-296-9777
Practice Address - Street 1:25214 BOROUGH PARK DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77380-3519
Practice Address - Country:US
Practice Address - Phone:281-296-7770
Practice Address - Fax:281-296-9777
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1481208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX133443503Medicaid
TX133443503Medicaid