Provider Demographics
NPI:1508945882
Name:GIDDINGS, SHELLEYANNE EUGENIE (MD)
Entity Type:Individual
Prefix:
First Name:SHELLEYANNE
Middle Name:EUGENIE
Last Name:GIDDINGS
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 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:2510 W GRAND PKWY N
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-2853
Practice Address - Country:US
Practice Address - Phone:713-442-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0499208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX044259205Medicaid
TX044259206Medicaid
TX044259201Medicaid
TXTXB115176Medicare PIN
TX044259202Medicaid
TX044259205Medicaid