Healthcare Provider Details

I. General information

NPI: 1437976990
Provider Name (Legal Business Name): ELLEN SHI LI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 10/15/2024
Certification Date: 10/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18123 UPPER BAY RD STE 400
HOUSTON TX
77058-3875
US

IV. Provider business mailing address

18123 UPPER BAY RD STE 400
HOUSTON TX
77058-3875
US

V. Phone/Fax

Practice location:
  • Phone: 281-333-1703
  • Fax:
Mailing address:
  • Phone: 281-333-1703
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: