Provider Demographics
NPI:1518456714
Name:VAIDYA, SHUBHA
Entity Type:Individual
Prefix:
First Name:SHUBHA
Middle Name:
Last Name:VAIDYA
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 1:1311 W SAM HOUSTON PKWY N STE 150
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77043-4015
Mailing Address - Country:US
Mailing Address - Phone:866-506-2626
Mailing Address - Fax:800-696-0607
Practice Address - Street 1:1311 W SAM HOUSTON PKWY N STE 150
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77043-4015
Practice Address - Country:US
Practice Address - Phone:866-506-2626
Practice Address - Fax:800-696-0607
Is Sole Proprietor?:No
Enumeration Date:2018-05-03
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist