Provider Demographics
NPI:1003205360
Name:SHIOMA WELLNESS CENTER, PA
Entity Type:Organization
Organization Name:SHIOMA WELLNESS CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHYLLIS
Authorized Official - Middle Name:CHIZOMAM
Authorized Official - Last Name:OKEREKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-501-3666
Mailing Address - Street 1:5433 WESTHEIMER RD
Mailing Address - Street 2:# 420
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-5399
Mailing Address - Country:US
Mailing Address - Phone:281-501-3666
Mailing Address - Fax:
Practice Address - Street 1:5433 WESTHEIMER RD
Practice Address - Street 2:# 420
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77056-5399
Practice Address - Country:US
Practice Address - Phone:281-501-3666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9375207W00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty