Healthcare Provider Details

I. General information

NPI: 1083102115
Provider Name (Legal Business Name): SARAH SHELBY COYLE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 04/12/2022
Certification Date: 04/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6431 FANNIN STREET SUITE MSB 3.151
HOUSTON TX
77030
US

IV. Provider business mailing address

6431 FANNIN STREET SUITE MSB 3.151
HOUSTON TX
77030
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-5800
  • Fax: 713-500-5805
Mailing address:
  • Phone: 713-500-5800
  • Fax: 713-500-5805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT1925
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: