Healthcare Provider Details

I. General information

NPI: 1730579541
Provider Name (Legal Business Name): MICHELLE JAVIER SHENOY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2015
Last Update Date: 01/13/2021
Certification Date: 01/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BAYLOR PLZ BCM 320
HOUSTON TX
77030-3411
US

IV. Provider business mailing address

1330 OLD SPANISH TRL APT 8207
HOUSTON TX
77054-1837
US

V. Phone/Fax

Practice location:
  • Phone: 832-824-1170
  • Fax:
Mailing address:
  • Phone: 312-622-7573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR8020
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: