Provider Demographics
NPI:1255318044
Name:BEHARA, SHAILAJA SAVITRI (MD)
Entity type:Individual
Prefix:
First Name:SHAILAJA
Middle Name:SAVITRI
Last Name:BEHARA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 132889
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77393-2889
Mailing Address - Country:US
Mailing Address - Phone:281-528-1511
Mailing Address - Fax:281-419-8485
Practice Address - Street 1:920 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 480
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77380-3260
Practice Address - Country:US
Practice Address - Phone:281-528-1511
Practice Address - Fax:281-419-8485
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL1801207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F20663Medicare PIN
TXH36706Medicare UPIN