Healthcare Provider Details

I. General information

NPI: 1285121517
Provider Name (Legal Business Name): SHELBY RHEA BONN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 09/30/2022
Certification Date: 09/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 WEST LOOP S STE 800
BELLAIRE TX
77401-3505
US

IV. Provider business mailing address

6565 WEST LOOP S STE 800
BELLAIRE TX
77401-3505
US

V. Phone/Fax

Practice location:
  • Phone: 713-661-4383
  • Fax: 713-661-4346
Mailing address:
  • Phone: 713-661-4383
  • Fax: 713-661-4346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA11820
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: