Provider Demographics
NPI:1952453441
Name:SHAH, PUNITA (MD)
Entity Type:Individual
Prefix:DR
First Name:PUNITA
Middle Name:
Last Name:SHAH
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 1:6300 STONEWOOD DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5280
Mailing Address - Country:US
Mailing Address - Phone:972-769-8700
Mailing Address - Fax:972-769-8728
Practice Address - Street 1:6300 STONEWOOD DR
Practice Address - Street 2:SUITE 206
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5280
Practice Address - Country:US
Practice Address - Phone:972-769-8700
Practice Address - Fax:972-769-8728
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL7554208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1624991-04Medicaid