Provider Demographics
NPI:1942341029
Name:KAMDAR, SHOBHANA JAGAT (MD)
Entity Type:Individual
Prefix:DR
First Name:SHOBHANA
Middle Name:JAGAT
Last Name:KAMDAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4654 HIGHWAY 6 N STE 307
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-2879
Mailing Address - Country:US
Mailing Address - Phone:281-463-9339
Mailing Address - Fax:281-906-6448
Practice Address - Street 1:4654 HIGHWAY 6 N STE 307
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2879
Practice Address - Country:US
Practice Address - Phone:281-463-9339
Practice Address - Fax:281-463-2921
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2022-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7433208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120491901Medicaid
TX120491901Medicaid