Provider Demographics
NPI:1184600041
Name:MEHTA, SHAILESH NEIL (MD)
Entity type:Individual
Prefix:DR
First Name:SHAILESH
Middle Name:NEIL
Last Name:MEHTA
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:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2213
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:3051 CHURCHILL DR STE 120
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75022-5900
Practice Address - Country:US
Practice Address - Phone:469-496-2860
Practice Address - Fax:469-496-2861
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2021-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3338207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103417503Medicaid
TX80140SOtherBCBS
TXK3338OtherMEDICAL LICENSE
TX103417503Medicaid
TX100012605Medicare PIN
TX8183B0Medicare PIN