Provider Demographics
NPI:1215083894
Name:BANSAL, SHWETA (MD)
Entity type:Individual
Prefix:
First Name:SHWETA
Middle Name:
Last Name:BANSAL
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 1:7703 FLOYD CURL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-4000
Mailing Address - Fax:210-450-4903
Practice Address - Street 1:701 S ZARZAMORA ST
Practice Address - Street 2:MAIL STOP 3-5
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5209
Practice Address - Country:US
Practice Address - Phone:210-450-4000
Practice Address - Fax:210-450-4903
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2394207RN0300X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX206443803OtherMEDICAID (CSHCN)
TX206443802Medicaid
TX206443803OtherMEDICAID (CSHCN)