Provider Demographics
NPI:1326542986
Name:MILES, SHAUN SAMUEL
Entity Type:Individual
Prefix:
First Name:SHAUN
Middle Name:SAMUEL
Last Name:MILES
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 1:11511 KATY FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77079-1903
Mailing Address - Country:US
Mailing Address - Phone:346-212-6661
Mailing Address - Fax:346-212-6661
Practice Address - Street 1:11511 KATY FWY STE 135
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-1984
Practice Address - Country:US
Practice Address - Phone:832-272-1647
Practice Address - Fax:281-313-2418
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14708899343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)