Provider Demographics
NPI:1689666414
Name:LISS, SHELLY E (MD)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:E
Last Name:LISS
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 1:15 E GREENWAY PLZ
Mailing Address - Street 2:#19-G
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77046-1509
Mailing Address - Country:US
Mailing Address - Phone:713-963-8401
Mailing Address - Fax:
Practice Address - Street 1:15 E GREENWAY PLZ
Practice Address - Street 2:#19-G
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77046-1509
Practice Address - Country:US
Practice Address - Phone:713-963-8401
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXC 9051208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation