Provider Demographics
NPI:1326425281
Name:PANCHAL, SHYAM
Entity Type:Individual
Prefix:
First Name:SHYAM
Middle Name:
Last Name:PANCHAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17189 INTERSTATE 45 S STE 675
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77385-3320
Mailing Address - Country:US
Mailing Address - Phone:936-270-3900
Mailing Address - Fax:936-271-1584
Practice Address - Street 1:17189 INTERSTATE 45 S STE 675
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-3320
Practice Address - Country:US
Practice Address - Phone:936-270-3900
Practice Address - Fax:936-271-1584
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS18862084V0102X, 2084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular NeurologyGroup - Multi-Specialty