Provider Demographics
NPI:1356423453
Name:SHORI, VANITA D (MD)
Entity type:Individual
Prefix:
First Name:VANITA
Middle Name:D
Last Name:SHORI
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1855
Mailing Address - Fax:682-885-1396
Practice Address - Street 1:1600 W NORTHWEST HWY
Practice Address - Street 2:STE 900
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-8112
Practice Address - Country:US
Practice Address - Phone:817-347-2530
Practice Address - Fax:817-488-5096
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2646208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX140442888Medicaid
TXSHOV362863OtherCCHIP PIN
TX149259100OtherFIRSTCARE PIN
TX1958879OtherFIRSTHEALTH PIN
TX151816901Medicaid
TX2153492OtherUHC PIN
TX00U87ZOtherBCBSTX GRP PIN
TX7198225OtherAETNA PIN
TX8642163OtherCIGNA PIN
TX89872YOtherBCBSTX IND PIN
TX140442891Medicaid
TX1750369203OtherGRP NPI NUMBER
TX2153492OtherUHC PIN
H50588Medicare UPIN
TX8796B6Medicare PIN