Provider Demographics
NPI:1689649303
Name:SAYA, SHOAIB H (MD)
Entity Type:Individual
Prefix:
First Name:SHOAIB
Middle Name:H
Last Name:SAYA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:987 N WALNUT CREEK DR STE 101
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-8016
Mailing Address - Country:US
Mailing Address - Phone:682-214-4405
Mailing Address - Fax:682-214-3404
Practice Address - Street 1:987 N WALNUT CREEK DR STE 101
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-8016
Practice Address - Country:US
Practice Address - Phone:682-214-4405
Practice Address - Fax:682-214-3404
Is Sole Proprietor?:No
Enumeration Date:2006-02-17
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23341207P00000X, 207RC0000X
TXN2781207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710589122OtherMEDICAID
OK200017670AMedicaid
TX1710589122OtherBCBS
TX1710589122Medicaid
TX207309001Medicaid