Provider Demographics
NPI:1114936911
Name:SHANDERA, WAYNE XAVIER (MD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:XAVIER
Last Name:SHANDERA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2235 NORTH BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77098-5209
Mailing Address - Country:US
Mailing Address - Phone:713-529-3475
Mailing Address - Fax:713-798-6400
Practice Address - Street 1:1504 TAUB LOOP
Practice Address - Street 2:BTGH 2RM-81-001
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-1608
Practice Address - Country:US
Practice Address - Phone:713-873-3389
Practice Address - Fax:713-798-6400
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2223207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP081J2748Medicaid
C21659Medicare UPIN
TXP081J2748Medicaid