MEDICARE: SHELLEY A. SEKULA, M.D. P.A.

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	207N00000X	Dermatology Physician	G2838	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4205607	OTHER	TX	AETNA

General Provider Information

NPI Number	:	1629130380
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELLEY A. SEKULA, M.D. P.A.

Provider Business Mailing Address
First Line	:	17300 EL CAMINO REAL
Second Line	:	SUITE NUMBER 103
City	:	HOUSTON
State	:	TX
Zip	:	77058-2715
Country	:	US
Telephone Number	:	281-480-7546
Fax Number	:	281-480-5324

Provider Business Practice Location Address
First Line	:	17300 EL CAMINO REAL
Second Line	:	SUITE NUMBER 103
City	:	HOUSTON
State	:	TX
Zip	:	77058-2715
Country	:	US
Telephone Number	:	281-480-7546
Fax Number	:	281-480-5324

Authorized Official
Title or Position	:	PRESIDENT AND OWNER
Name	:	SHELLEY SEKULA GIBBS
Credential	:	M.D.
Telephone Number	:	281-480-7546

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	07/03/2008

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