Provider Demographics
NPI:1780909135
Name:SHAH, ANITA R (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:R
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:N
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 N FM 548, SUITE 100
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126
Mailing Address - Country:US
Mailing Address - Phone:972-646-3346
Mailing Address - Fax:972-564-2079
Practice Address - Street 1:101 N FM 548, SUITE 100
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126
Practice Address - Country:US
Practice Address - Phone:972-646-3346
Practice Address - Fax:972-564-2079
Is Sole Proprietor?:No
Enumeration Date:2010-03-29
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP4690208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics