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General NPI Number Information
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NPI Number | 1003205360
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Entity Type | Organization
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Legal Business Name | SHIOMA WELLNESS CENTER, PA
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Dates
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Enumeration Date | 01/09/2015
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Last Update Date | 01/09/2015
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Provider Practice Location Address
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Address Line | 5433 WESTHEIMER RD # 420
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City | HOUSTON
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State | TX
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Zip | 77056-5399
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Country | US
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Telephone | 281-501-3666
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Fax |
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Provider Business Mailing Address
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Address Line | 5433 WESTHEIMER RD # 420
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City | HOUSTON
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State | TX
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Zip | 77056-5399
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Country | US
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Telephone | 281-501-3666
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHYLLIS CHIZOMAM OKEREKE
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Credential | MD
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Telephone | 281-501-3666
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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License Number | K9375
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | K9375
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License Number State | TX
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