Provider Demographics
NPI:1699027482
Name:RUBIN, SHANTHI E (CNS)
Entity Type:Individual
Prefix:
First Name:SHANTHI
Middle Name:E
Last Name:RUBIN
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 WESTCOTT ST
Mailing Address - Street 2:STE 520
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-9015
Mailing Address - Country:US
Mailing Address - Phone:713-864-6694
Mailing Address - Fax:713-864-6698
Practice Address - Street 1:550 WESTCOTT ST
Practice Address - Street 2:STE 520
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-9015
Practice Address - Country:US
Practice Address - Phone:713-864-6694
Practice Address - Fax:713-864-6698
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-04
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX541329364SP0808X, 364SP0809X
TXTX541329163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTX541329OtherAPN LICENSE
TX335251YLGNMedicare PIN