Individual
DR. TINA DINESH SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PSYD, LP
Contact information
Practice address
12400 PORTLAND AVE STE 120, BURNSVILLE, MN 55337-6817
(612) 276-2462
(612) 246-3682
Mailing address
4660 SLATER RD STE 120, EAGAN, MN 55122-4048
(612) 276-2462
(612) 246-3682
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
5012
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
680002766
MEDICARE PTAN
MN
Enumeration date
01/07/2009
Last updated
04/25/2024
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