Healthcare Provider Details

I. General information

NPI: 1255006789
Provider Name (Legal Business Name): PAULO VELARDE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2021
Last Update Date: 08/16/2021
Certification Date: 08/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17201 I 45 S
SHENANDOAH TX
77385-3311
US

IV. Provider business mailing address

17201 I 45 S
SHENANDOAH TX
77385-3311
US

V. Phone/Fax

Practice location:
  • Phone: 936-270-2000
  • Fax:
Mailing address:
  • Phone: 936-270-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1046367
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: