Healthcare Provider Details

I. General information

NPI: 1154686640
Provider Name (Legal Business Name): MICHELLE CHOUT-WIN SHEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2012
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17510 W GRAND PKWY S STE 190
SUGAR LAND TX
77479-2647
US

IV. Provider business mailing address

17510 W GRAND PKWY S STE 190
SUGAR LAND TX
77479-2647
US

V. Phone/Fax

Practice location:
  • Phone: 713-486-1330
  • Fax:
Mailing address:
  • Phone: 713-486-1330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number25MA10220500
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number25MA10220500
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberMD457617
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberP3584
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: