Healthcare Provider Details

I. General information

NPI: 1740415447
Provider Name (Legal Business Name): MOSTAFA HELMY AHMED MOHAMED SHALABY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2009
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD 5.106 JSA
GALVESTON TX
77555-0553
US

IV. Provider business mailing address

301 UNIVERSITY BLVD 5.106 JSA
GALVESTON TX
77555-0553
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-1533
  • Fax: 409-772-4982
Mailing address:
  • Phone: 409-772-1533
  • Fax: 409-772-4982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberBP10052127
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: