MEDICARE: SALLY FLEMING SHU MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	G2025	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	234686	OTHER	TX	BEECHSTREET
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609861343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY FLEMING SHU MD

Provider Business Mailing Address
First Line	:	10740 N GESSNER DR
Second Line	:	STE 310
City	:	HOUSTON
State	:	TX
Zip	:	77064-1240
Country	:	US
Telephone Number	:	281-897-0416
Fax Number	:	281-890-8908

Provider Business Practice Location Address
First Line	:	17070 RED OAK DR
Second Line	:	STE 205
City	:	HOUSTON
State	:	TX
Zip	:	77090-2615
Country	:	US
Telephone Number	:	281-440-0734
Fax Number	:	281-440-8065

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	07/27/2010

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