Provider Demographics
NPI:1942769682
Name:TEYA, SHEM M (FNP-C)
Entity Type:Individual
Prefix:
First Name:SHEM
Middle Name:M
Last Name:TEYA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2940 BROADWAY BLVD STE 15
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75041-3749
Mailing Address - Country:US
Mailing Address - Phone:972-212-4586
Mailing Address - Fax:469-298-0779
Practice Address - Street 1:2940 BROADWAY BLVD STE 15
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75041-3749
Practice Address - Country:US
Practice Address - Phone:972-212-4586
Practice Address - Fax:469-298-0779
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2021-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140922363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily