Active NPI
Shahin Etezadi-Amoli, M.D., M.P.H.
- Pediatrics Physician
- Irving, TX
National Provider Identifier
1316180359
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- F2474
- Practice address
- 5001 Statesman Dr
Irving, TX 75063-2414 - Phone
- (800) 685-2272
- NPI assigned
- Apr 7, 2009
- 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 | F2474 | TX | Primary |
Addresses
Primary practice location
5001 Statesman Dr
Irving, TX 75063-2414
Mailing address
4106 Lakeside Dr
Rowlett, TX 75088-5553
Phone (972) 412-4222
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| F2474 | TX | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1239062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1239062400000",
"number": "1316180359",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4106 LAKESIDE DR",
"city": "ROWLETT",
"state": "TX",
"postal_code": "750885553",
"telephone_number": "972-412-4222"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5001 STATESMAN DR",
"city": "IRVING",
"state": "TX",
"postal_code": "750632414",
"telephone_number": "800-685-2272"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ETEZADI-AMOLI",
"first_name": "SHAHIN",
"name_prefix": "Dr.",
"credential": "M.D., M.P.H.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2009-04-07",
"last_updated": "2009-04-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "TX",
"license": "F2474",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irving, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.