Provider Demographics
NPI:1568785178
Name:BENNY VARGHESE, SHAINY (PHD, RN, CPNP)
Entity Type:Individual
Prefix:DR
First Name:SHAINY
Middle Name:
Last Name:BENNY VARGHESE
Suffix:
Gender:F
Credentials:PHD, RN, CPNP
Other - Prefix:
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Mailing Address - Street 1:2503 S MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-5544
Mailing Address - Country:US
Mailing Address - Phone:281-261-5800
Mailing Address - Fax:281-261-5885
Practice Address - Street 1:2503 S MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-5544
Practice Address - Country:US
Practice Address - Phone:281-261-5800
Practice Address - Fax:281-261-5885
Is Sole Proprietor?:No
Enumeration Date:2010-03-10
Last Update Date:2022-12-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX603668363LP0200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1962840074OtherNPI
TX603668OtherSTATE LICENSE
TX603668OtherSTATE LICENSE