Provider Demographics
NPI:1043252448
Name:SHIMPI BHALLA, AMITA (MD)
Entity type:Individual
Prefix:DR
First Name:AMITA
Middle Name:
Last Name:SHIMPI BHALLA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMITA
Other - Middle Name:V
Other - Last Name:BHALLA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:5413 CRENSHAW ROAD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-3143
Mailing Address - Country:US
Mailing Address - Phone:713-943-2800
Mailing Address - Fax:713-943-2801
Practice Address - Street 1:5413 CRENSHAW RD
Practice Address - Street 2:SUITE 400
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3143
Practice Address - Country:US
Practice Address - Phone:713-943-2800
Practice Address - Fax:713-943-2801
Is Sole Proprietor?:No
Enumeration Date:2006-06-11
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3388207RS0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI52117Medicare UPIN