Healthcare Provider Details

I. General information

NPI: 1164898557
Provider Name (Legal Business Name): SHELLY K. BROLINE, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2015
Last Update Date: 01/20/2026
Certification Date: 01/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 SILVERBELL CT
BRYAN TX
77807-1601
US

IV. Provider business mailing address

3014 SILVERBELL CT
BRYAN TX
77807-1601
US

V. Phone/Fax

Practice location:
  • Phone: 713-446-2526
  • Fax:
Mailing address:
  • Phone: 713-446-2526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberL9112
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberL9112
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberL9112
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License NumberL9112
License Number StateTX

VIII. Authorized Official

Name: SHELLY BROLINE SITTON
Title or Position: PRESIDENT
Credential:
Phone: 713-446-2526