Provider Demographics
NPI:1083865133
Name:DAIGLE, SHELLY MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:MARIE
Last Name:DAIGLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12550 LOUETTA RD
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-2139
Mailing Address - Country:US
Mailing Address - Phone:281-257-7792
Mailing Address - Fax:
Practice Address - Street 1:12550 LOUETTA RD
Practice Address - Street 2:
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77429-2139
Practice Address - Country:US
Practice Address - Phone:281-257-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09052363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant