Provider Demographics
NPI:1821230319
Name:SHAH, AVANTHI TAYI (MD)
Entity Type:Individual
Prefix:DR
First Name:AVANTHI
Middle Name:TAYI
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AVANTHI
Other - Middle Name:
Other - Last Name:TAYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-456-2382
Mailing Address - Fax:214-456-6133
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-1811
Practice Address - Country:US
Practice Address - Phone:214-456-2382
Practice Address - Fax:214-456-6133
Is Sole Proprietor?:No
Enumeration Date:2009-03-30
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA124972208000000X, 2080P0207X
TXP3978208000000X, 2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics