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Individual

SYED NAYYAR SHAH

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1001 12TH AVE STE 134, FORT WORTH, TX 76104-3927
(817) 880-6620
(817) 880-6621
Mailing address
1001 12TH AVE STE 134, FORT WORTH, TX 76104-3927
(817) 880-6620
(817) 880-6621

Taxonomy

Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
L0931
TX
207RC0001X
Clinical Cardiac Electrophysiology Physician
Primary
L0931
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
10032328
AMERIGROUP
TX
05
1050387-01
TX
05
1050387-02
TX
01
310501YT79
MEDICARE
TX
01
5919753
AETNA PROVIDER ID
TX
01
86466K
BCBS
TX
Enumeration date
05/15/2006
Last updated
05/22/2024
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