Provider Demographics
NPI:1407839848
Name:SHUNG, SHEILA (MD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:SHUNG
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 1:12319 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
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-21
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1747207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1505323-01Medicaid
TX1505323-01Medicaid
TXH59424Medicare UPIN