Provider Demographics
NPI:1255421483
Name:SHENAQ, JAY M (MD)
Entity type:Individual
Prefix:DR
First Name:JAY
Middle Name:M
Last Name:SHENAQ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16605 SOUTHWEST FWY
Mailing Address - Street 2:STE 510
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:832-532-7100
Mailing Address - Fax:832-532-7410
Practice Address - Street 1:1111 HIGHWAY 6 STE 10
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-4917
Practice Address - Country:US
Practice Address - Phone:832-532-7100
Practice Address - Fax:832-532-7410
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52028208200000X
TXJ5674208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030565801Medicaid
53AVOtherBCBS TX
53AVOtherBCBS TX
G38320Medicare UPIN