Active NPI
Shaila Sampat Gavande, MD
- Pediatrics Physician
- Fortworth, TX
National Provider Identifier
1043228463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- E4348
- Practice address
- 2245 58TH St
Thomas Moore Health Clinic
Fortworth, TX 76544 - Phone
- (254) 285-6269
- NPI assigned
- Aug 3, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | E4348 | TX | Primary |
Addresses
Primary practice location
2245 58TH St
Thomas Moore Health Clinic
Fortworth, TX 76544
Mailing address
4501 Upvalley Court
Austin, TX 78731
Phone (512) 451-1400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| E4348 | Other | TX | TEXAS LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E4348 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154563200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1043228463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4501 UPVALLEY COURT",
"city": "AUSTIN",
"state": "TX",
"postal_code": "78731",
"telephone_number": "512-451-1400",
"fax_number": "512-451-1400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2245 58TH ST",
"address_2": "THOMAS MOORE HEALTH CLINIC",
"city": "FORTWORTH",
"state": "TX",
"postal_code": "76544",
"telephone_number": "254-285-6269"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAVANDE",
"first_name": "SHAILA",
"middle_name": "SAMPAT",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-08-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "E4348",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TEXAS LICENSE",
"identifier": "E4348",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fortworth, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.