Provider Demographics
NPI:1013764661
Name:ACEVEDO PEREZ, SHAKESPEARE (SA-C)
Entity type:Individual
Prefix:
First Name:SHAKESPEARE
Middle Name:
Last Name:ACEVEDO PEREZ
Suffix:
Gender:M
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7606 CHASECREEK DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77489-1874
Mailing Address - Country:US
Mailing Address - Phone:346-901-4971
Mailing Address - Fax:
Practice Address - Street 1:4120 SOUTHWEST FWY STE 230
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-7327
Practice Address - Country:US
Practice Address - Phone:281-254-8206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21-379246ZC0007X
TXSA00941363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant