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General NPI Number Information
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NPI Number | 1700824158
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Entity Type | Individual
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Provider Name | SHARI MCCONVILLE KUSHWAHA M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/04/2006
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Last Update Date | 03/20/2009
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Provider Practice Location Address
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Address Line | 1670 KELLER PKWY SUITE 170
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City | KELLER
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State | TX
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Zip | 76248-3702
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Country | US
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Telephone | 817-741-4144
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Fax | 817-741-4154
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Provider Business Mailing Address
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Address Line | 1670 KELLER PKWY SUITE 170
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City | KELLER
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State | TX
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Zip | 76248-3702
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Country | US
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Telephone | 817-741-4144
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Fax | 817-741-4154
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | L7791
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License Number State | TX
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