Healthcare Provider Details

I. General information

NPI: 1720513542
Provider Name (Legal Business Name): SHYAM JAVVAJI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/30/2017
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-3358
US

IV. Provider business mailing address

301 UNIVERSITY BLVD, 5.504 JENNIE SEALY HOSPITAL
GALVESTON TX
77555-0877
US

V. Phone/Fax

Practice location:
  • Phone: 409-266-7856
  • Fax:
Mailing address:
  • Phone: 409-266-7856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: