Provider Demographics
NPI:1629130380
Name:SHELLEY A. SEKULA, M.D. P.A.
Entity Type:Organization
Organization Name:SHELLEY A. SEKULA, M.D. P.A.
Other - Org Name:BAY OAKS DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEKULA GIBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-480-7546
Mailing Address - Street 1:17300 EL CAMINO REAL
Mailing Address - Street 2:SUITE NUMBER 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2715
Mailing Address - Country:US
Mailing Address - Phone:281-480-7546
Mailing Address - Fax:281-480-5324
Practice Address - Street 1:17300 EL CAMINO REAL
Practice Address - Street 2:SUITE NUMBER 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2715
Practice Address - Country:US
Practice Address - Phone:281-480-7546
Practice Address - Fax:281-480-5324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2838207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4205607OtherAETNA
TX4205607OtherAETNA
TX00982XMedicare PIN