Healthcare Provider Details

I. General information

NPI: 1457666570
Provider Name (Legal Business Name): MOHAMED ALI SHETA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13656 BRETON RIDGE ST UNIT A&H
HOUSTON TX
77070-6081
US

IV. Provider business mailing address

850 W RIO SALADO PKWY STE 201
TEMPE AZ
85281-3812
US

V. Phone/Fax

Practice location:
  • Phone: 281-429-8780
  • Fax: 281-763-7930
Mailing address:
  • Phone: 480-480-8330
  • Fax: 480-393-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberS4871
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number37459
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberS4871
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: