Provider Demographics
NPI:1730105560
Name:VAIDYA, SHILPA (MD)
Entity Type:Individual
Prefix:
First Name:SHILPA
Middle Name:
Last Name:VAIDYA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:6704 STERLING RIDGE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77382-2799
Mailing Address - Country:US
Mailing Address - Phone:281-737-2611
Mailing Address - Fax:936-273-2100
Practice Address - Street 1:6704 STERLING RIDGE DR
Practice Address - Street 2:SUITE A
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77382-2799
Practice Address - Country:US
Practice Address - Phone:281-737-2611
Practice Address - Fax:936-273-2100
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXM3101207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202642903Medicaid
TX202642902Medicaid
TX00J21AOtherGROUP MEDICARE
TX094010801OtherGROUP MEDICAID
TX8FT541OtherBLUE CROSS BLUE SHIELD
TX8S3659OtherBCBS
TX8S3659OtherBCBS
TX202642902Medicaid
TXTXB151601Medicare PIN