Angel Shibu, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA19530 Issued in TX

Practice address

2701 Prince George Ave Ste 100
Desoto, TX 75115-2087

Phone

(972) 634-8110

NPI assigned

Sep 8, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

University of Texas Medical Branch at Galveston, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• The Dallas Clinic 23 PLLC

  • Internal Medicine Physician
  • Desoto, TX
  • NPI 1255197653
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1757289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1759708800000",
    "number": "1073494191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2701 PRINCE GEORGE AVE STE 100",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152087",
            "telephone_number": "972-634-8110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2701 PRINCE GEORGE AVE STE 100",
            "city": "DESOTO",
            "state": "TX",
            "postal_code": "751152087",
            "telephone_number": "972-634-8110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHIBU",
        "first_name": "ANGEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-09-08",
        "last_updated": "2025-10-06",
        "certification_date": "2025-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA19530",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Latricia Lanell Shaw, LCSW
• Korie Lynne Sheets, ATC,LAT
• Shepherd Specialty Pharmacy LLC
• Brenda Gay Shepherd, R.N.
• Patricia Ann Sherfield
• Anita Shiwach
• Rajinder Shiwach, MD
• Haji-Sheikh Keith Shoulders, LCSW
• Janet Sims, LPC
• Tiffany Lashae-Della Sims, NP

• Physician Assistant in Desoto, TX
• Providers in Desoto, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.