Provider Demographics
NPI:1265447320
Name:SHIEH, SUE MABEN (MD)
Entity Type:Individual
Prefix:
First Name:SUE
Middle Name:MABEN
Last Name:SHIEH
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:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:4515 SETON CENTER PKWY #220
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5784
Practice Address - Country:US
Practice Address - Phone:512-338-8388
Practice Address - Fax:512-338-8465
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5342208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143182701Medicaid
TX143182702Medicaid
TX143182704Medicaid
TX143182703Medicaid
TXTXB134021Medicare PIN
TX143182703Medicaid
TX8K1796Medicare PIN
TX143182704Medicaid
TXTXB119287Medicare PIN