Provider Demographics
NPI:1669446670
Name:VALENTINE, SHYLA THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:SHYLA
Middle Name:THOMAS
Last Name:VALENTINE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N HALL ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1339
Mailing Address - Country:US
Mailing Address - Phone:469-800-7400
Mailing Address - Fax:469-800-7440
Practice Address - Street 1:4211 JOE RAMSEY BLVD E
Practice Address - Street 2:SUITE 108
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7852
Practice Address - Country:US
Practice Address - Phone:469-800-3400
Practice Address - Fax:469-800-3410
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ4558207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX036992804Medicaid
TX145164302Medicaid
TX036992805Medicaid
TX145164301Medicaid
TX258634YKTPMedicare PIN
TX00558RMedicare PIN
TX258634YKY6Medicare PIN
TX145164302Medicaid
TXP01102900Medicare PIN