Provider Demographics
NPI:1497168546
Name:SHAUN S. VARGHESE, M.D., PLLC
Entity Type:Organization
Organization Name:SHAUN S. VARGHESE, M.D., PLLC
Other - Org Name:THE HOUSTON INSTITUTE OF NEUROLOGY FOR KIDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAUN
Authorized Official - Middle Name:S
Authorized Official - Last Name:VARGHESE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-767-8365
Mailing Address - Street 1:920 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77380-3260
Mailing Address - Country:US
Mailing Address - Phone:281-298-1144
Mailing Address - Fax:281-298-1133
Practice Address - Street 1:920 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 120
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3260
Practice Address - Country:US
Practice Address - Phone:281-298-1144
Practice Address - Fax:281-298-1133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP97602080P0008X, 2084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Multi-Specialty
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX339121101Medicaid