Provider Demographics
NPI:1609861343
Name:SHU, SALLY FLEMING (MD)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:FLEMING
Last Name:SHU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SALLY
Other - Middle Name:
Other - Last Name:FLEMING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10740 N GESSNER DR
Mailing Address - Street 2:STE 310
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77064-1240
Mailing Address - Country:US
Mailing Address - Phone:281-897-0416
Mailing Address - Fax:281-890-8908
Practice Address - Street 1:17070 RED OAK DR
Practice Address - Street 2:STE 205
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2615
Practice Address - Country:US
Practice Address - Phone:281-440-0734
Practice Address - Fax:281-440-8065
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2025207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX234686OtherBEECHSTREET
TX100086101Medicaid
TXC21790Medicare UPIN
TX234686OtherBEECHSTREET
TX100086101Medicaid