Provider Demographics
NPI:1053373001
Name:SHAH, AMI R (MD)
Entity type:Individual
Prefix:DR
First Name:AMI
Middle Name:R
Last Name:SHAH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:AMI
Other - Middle Name:R
Other - Last Name:PATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6124 WEST PARKER ROAD
Mailing Address - Street 2:MOB III SUITE 234
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-8124
Mailing Address - Country:US
Mailing Address - Phone:972-981-7500
Mailing Address - Fax:972-981-3600
Practice Address - Street 1:6124 WEST PARKER ROAD
Practice Address - Street 2:MOB III SUITE 234
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-8124
Practice Address - Country:US
Practice Address - Phone:972-981-7500
Practice Address - Fax:972-981-3600
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7347207Q00000X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXN7347OtherSTATE LICENSE
TXN7347OtherSTATE LICENSE
H75777Medicare UPIN