Provider Demographics
NPI:1376100347
Name:REYES-WIDRICK, SHELBY L
Entity type:Individual
Prefix:
First Name:SHELBY
Middle Name:L
Last Name:REYES-WIDRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 MOULTRIE LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77084-7118
Mailing Address - Country:US
Mailing Address - Phone:832-906-5790
Mailing Address - Fax:
Practice Address - Street 1:955 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2803
Practice Address - Country:US
Practice Address - Phone:713-464-1511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-23
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech