Provider Demographics
NPI:1457602492
Name:SHAH, BINA S (FNP)
Entity Type:Individual
Prefix:
First Name:BINA
Middle Name:S
Last Name:SHAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S IRVING HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75060-6237
Mailing Address - Country:US
Mailing Address - Phone:972-579-7979
Mailing Address - Fax:972-554-4592
Practice Address - Street 1:1111 S IRVING HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75060-6237
Practice Address - Country:US
Practice Address - Phone:972-579-7979
Practice Address - Fax:972-554-4592
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-01
Last Update Date:2020-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122417363LP0808X
TX823531363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty