Healthcare Provider Details

I. General information

NPI: 1730749003
Provider Name (Legal Business Name): SHELBY ANASTASIA BEEM DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2019
Last Update Date: 08/25/2022
Certification Date: 08/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 W PARKWOOD AVE
FRIENDSWOOD TX
77546-5431
US

IV. Provider business mailing address

PO BOX 650859 DEPT 710
DALLAS TX
75265-2261
US

V. Phone/Fax

Practice location:
  • Phone: 281-482-5695
  • Fax: 254-313-4549
Mailing address:
  • Phone: 409-747-6240
  • Fax: 254-313-4549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP10067497
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT7867
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: