Provider Demographics
NPI:1952391161
Name:SHAH, CHAITANYA B (MD)
Entity Type:Individual
Prefix:
First Name:CHAITANYA
Middle Name:B
Last Name:SHAH
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 1:11307 FM 1960 RD W
Mailing Address - Street 2:STE. #125
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-3687
Mailing Address - Country:US
Mailing Address - Phone:281-894-4327
Mailing Address - Fax:281-894-4360
Practice Address - Street 1:11307 FM 1960 RD W
Practice Address - Street 2:STE. #125
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-3687
Practice Address - Country:US
Practice Address - Phone:281-894-4327
Practice Address - Fax:281-894-4360
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8332207RI0011X, 207UN0901X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology