Healthcare Provider Details

I. General information

NPI: 1124245121
Provider Name (Legal Business Name): HEART AND VASCULAR ASSOCIATION OF HOUSTON P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25312 INTERSTATE 45 N STE A
SPRING TX
77386-1449
US

IV. Provider business mailing address

17003 SOUTHWEST FWY STE 100
SUGAR LAND TX
77479-3480
US

V. Phone/Fax

Practice location:
  • Phone: 832-261-4808
  • Fax: 888-251-0385
Mailing address:
  • Phone: 832-261-4808
  • Fax: 888-251-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number8283
License Number StateTX

VIII. Authorized Official

Name: SHAILENDRA SHUKLA
Title or Position: ADMINISTRATOR
Credential:
Phone: 832-261-4808