MEDICARE: SHADY TANTAWY 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	390200000X	Student in an Organized Health Care Education/Training Program	BP10092651	TX

General Provider Information

NPI Number	:	1942163829
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHADY TANTAWY MD

Provider Business Mailing Address
First Line	:	1800 EL PASEO ST APT 2216
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-3017
Country	:	US
Telephone Number	:	346-204-9871
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 HOLCOMBE BLVD
Second Line	:	FC6.2020, JOHN MENDELSOHN FACULTY CENTER
City	:	HOUSTON
State	:	TX
Zip	:	77030-4008
Country	:	US
Telephone Number	:	346-204-9871
Fax Number	:

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

Provider Enumeration Date	:	12/08/2025
Last Update Date	:	12/31/2025

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