Provider Demographics
NPI:1871721076
Name:SHAH, TEJASKUMAR M
Entity type:Individual
Prefix:
First Name:TEJASKUMAR
Middle Name:M
Last Name:SHAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:196 CARDIOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-1174
Mailing Address - Country:US
Mailing Address - Phone:803-324-5135
Mailing Address - Fax:803-324-8161
Practice Address - Street 1:196 CARDIOLOGY DR
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-1174
Practice Address - Country:US
Practice Address - Phone:803-324-5135
Practice Address - Fax:803-324-8161
Is Sole Proprietor?:No
Enumeration Date:2009-06-25
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD40478207RC0000X
SC40478207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease