Provider Demographics
NPI:1447457759
Name:SHAISTA A HUSAIN, MD,PA
Entity type:Organization
Organization Name:SHAISTA A HUSAIN, MD,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAISTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:HUSAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-366-1477
Mailing Address - Street 1:10021 MAIN ST STE B1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5253
Mailing Address - Country:US
Mailing Address - Phone:832-366-1477
Mailing Address - Fax:832-366-1479
Practice Address - Street 1:10021 MAIN ST STE B1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5253
Practice Address - Country:US
Practice Address - Phone:832-366-1477
Practice Address - Fax:832-366-1479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-29
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207Y00000X
207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXDB9885OtherRRMEDICARE
TX0031QDOtherBCBSTX
TX151835901Medicaid
TXE12565Medicare UPIN
TXDB9885OtherRRMEDICARE