Basic Information
| Provider Information | |||||||||
| NPI: | 1093923757 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | GULAB | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12510 PROSPERITY DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209041663 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2404855200 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5550 FRIENDSHIP BLVD | ||||||||
| Address2: | SUITE T-90 | ||||||||
| City: | CHEVY CHASE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208157256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2407370085 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 02/08/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 0101244348 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 1093923757 | 05 | VA | MEDICAID |