Provider Demographics
NPI:1790816791
Name:SHETH, MONA NIRAJ (MD)
Entity Type:Individual
Prefix:
First Name:MONA
Middle Name:NIRAJ
Last Name:SHETH
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 1:16651 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 450
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2345
Mailing Address - Country:US
Mailing Address - Phone:281-275-0800
Mailing Address - Fax:281-275-0801
Practice Address - Street 1:16651 SOUTHWEST FWY
Practice Address - Street 2:SUITE 450
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2345
Practice Address - Country:US
Practice Address - Phone:281-275-0800
Practice Address - Fax:281-275-0801
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9480207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202763302Medicaid
TXP01114497OtherRR MEDICARE
TX1790816791OtherBLUE CROSS BLUE SHIELD
TX8EF701OtherBLUE CROSS BLUE SHIELD
TX202763303Medicaid
TX8J3977Medicare PIN
TX202763303Medicaid
TX8L22109Medicare PIN
TX8EF701OtherBLUE CROSS BLUE SHIELD