Provider Demographics
NPI:1407101132
Name:SHEILA SHUNG MD PLLC INTERNAL MEDICINE
Entity Type:Organization
Organization Name:SHEILA SHUNG MD PLLC INTERNAL MEDICINE
Other - Org Name:SHEILA SHUNG MD INTERNAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SOLE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-833-0140
Mailing Address - Street 1:12319 N MOPAC EXPY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-2403
Mailing Address - Country:US
Mailing Address - Phone:512-833-0140
Mailing Address - Fax:512-833-0142
Practice Address - Street 1:12319 N MOPAC EXPY
Practice Address - Street 2:SUITE 240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-2403
Practice Address - Country:US
Practice Address - Phone:512-833-0140
Practice Address - Fax:512-833-0142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1505323-01Medicaid
TX1505323-01Medicaid