| Shubha P Shetty Md Pa | |
|
4502 Riverstone Blvd Suite 1003 Missouri City TX 77459-5204 | |
| (972) 904-7683 | |
| Not Available |
| Full Name | Shubha P Shetty Md Pa |
|---|---|
| Speciality | Family Medicine |
| Location | 4502 Riverstone Blvd, Missouri City, Texas |
| Authorized Official Name and Position | Shubha Premnath Shetty (MD) |
| Authorized Official Contact | 9729047683 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shubha P Shetty Md Pa 4502 Riverstone Blvd Missouri City TX 77459-5204 Ph: (972) 904-7683 | Shubha P Shetty Md Pa 4502 Riverstone Blvd Suite 1003 Missouri City TX 77459-5204 Ph: (972) 904-7683 |
| NPI Number | 1245682384 |
|---|---|
| Provider Enumeration Date | 07/12/2016 |
| Last Update Date | 08/08/2016 |
| Medicare PECOS PAC ID | 1153601455 |
|---|---|
| Medicare Enrollment ID | O20161202000560 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245682384 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | N4096 (Texas) | Primary |
| 261QP2300X | Clinic/center - Primary Care | N4096 (Texas) | Secondary |
| Provider Name | Shubha P Shetty |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1760645295 PECOS PAC ID: 5395884530 Enrollment ID: I20091202000174 |
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