Provider Demographics
NPI:1154686640
Name:SHEN, MICHELLE CHOUT-WIN (MD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:CHOUT-WIN
Last Name:SHEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17510 W GRAND PKWY S STE 190
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2647
Mailing Address - Country:US
Mailing Address - Phone:713-486-1330
Mailing Address - Fax:
Practice Address - Street 1:17510 W GRAND PKWY S STE 190
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2647
Practice Address - Country:US
Practice Address - Phone:713-486-1330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-10
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA10220500208600000X, 2086X0206X
PAMD4576172086X0206X
TXP35842086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8DH743OtherBCBS
NJ0601322Medicaid
TX8DH743OtherBCBS