Provider Demographics
NPI:1518725431
Name:SHAJU, TESSY N (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:TESSY
Middle Name:N
Last Name:SHAJU
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 TALL TIMBERS LN
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-6553
Mailing Address - Country:US
Mailing Address - Phone:832-274-3139
Mailing Address - Fax:
Practice Address - Street 1:2107 TALL TIMBERS LN
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-6553
Practice Address - Country:US
Practice Address - Phone:832-274-3139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020308363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care