Shubha P Shetty MD PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

N4096 Issued in TX

Legal business name

SHUBHA P SHETTY MD PA

Practice address

4502 Riverstone Blvd
Suite 1003
Missouri City, TX 77459-5204

Phone

(972) 904-7683

NPI assigned

Jul 12, 2016

Organization subpart

No

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

Authorized official

Name

Shubha Premnath Shetty, MDNPI 1760645295

Title

MD

Phone

(972) 904-7683

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Shubha Premnath Shetty, MD

  • Family Medicine Physician
  • Missouri City, TX
  • NPI 1760645295
  Medicare reassignment NPD Authorized official
• Priya Ratna Madduri, APRN

  • Gerontology Nurse Practitioner
  • Houston, TX
  • NPI 1275216350
  NPD (past)
• Katrina Lazo Porte, FNP-C

  • Family Nurse Practitioner
  • Missouri City, TX
  • NPI 1710840327
  NPD (past)

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

{
    "created_epoch": "1468281600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1470614400000",
    "number": "1245682384",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4502 RIVERSTONE BLVD",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774595204",
            "telephone_number": "972-904-7683"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4502 RIVERSTONE BLVD",
            "address_2": "SUITE 1003",
            "city": "MISSOURI CITY",
            "state": "TX",
            "postal_code": "774595204",
            "telephone_number": "972-904-7683"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHUBHA P SHETTY MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-07-12",
        "last_updated": "2016-08-08",
        "status": "A",
        "authorized_official_last_name": "SHETTY",
        "authorized_official_first_name": "SHUBHA",
        "authorized_official_middle_name": "PREMNATH",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "972-904-7683",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "N4096",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "N4096",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shubha Premnath Shetty, MD
• Shining Stars Hospice Inc
• Olubukola Shobowale
• Amy Shore, LPC
• Paul Shrode
• Betty C G Shynett, DDS FAGD
• Yazdi Sidhwa, SA-C
• Sienna Advanced Dentistry and Implants
• Sienna Care LLC (spring green pharmacy 1)
• Sienna Caregivers, LLC (Sienna Caregivers)

• Family Medicine Physician in Missouri City, TX
• Providers in Missouri City, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.