MEDICARE: MRS. TEASIA SHIKELIA HAGAN-SHOCK

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	347C00000X	Private Vehicle	LLC6962	TX

General Provider Information

NPI Number	:	1992349914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TEASIA SHIKELIA HAGAN-SHOCK

Provider Business Mailing Address
First Line	:	5527 IRISH HILL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3519
Country	:	US
Telephone Number	:	832-542-3954
Fax Number	:

Provider Business Practice Location Address
First Line	:	5527 IRISH HILL DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77053-3519
Country	:	US
Telephone Number	:	832-542-3954
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2019
Last Update Date	:	11/01/2019

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Directions to “ MRS. TEASIA SHIKELIA HAGAN-SHOCK ” Practice Location

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