MEDICARE: SHANTI PAIN & WELLNESS CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	K4562	TX
2	111N00000X	Chiropractor

General Provider Information

NPI Number	:	1508060740
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHANTI PAIN & WELLNESS CLINIC

Provider Business Mailing Address
First Line	:	5611 BELLAIRE BLVD # 376
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-5617
Country	:	US
Telephone Number	:	713-339-1566
Fax Number	:	713-465-5965

Provider Business Practice Location Address
First Line	:	5611 BELLAIRE BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77081-5617
Country	:	US
Telephone Number	:	713-339-1566
Fax Number	:	713-465-5965

Authorized Official
Title or Position	:	OWNER
Name	:	IHSAN F SHANTI
Credential	:	MD
Telephone Number	:	713-339-1566

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	09/11/2025

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Directions to “SHANTI PAIN & WELLNESS CLINIC ” Practice Location

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