Provider Demographics
NPI:1295262129
Name:SLY, ZHAUNN MIKHAIL (MD)
Entity type:Individual
Prefix:
First Name:ZHAUNN
Middle Name:MIKHAIL
Last Name:SLY
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 1:3601 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79430-6211
Mailing Address - Country:US
Mailing Address - Phone:806-743-6147
Mailing Address - Fax:806-743-1599
Practice Address - Street 1:3601 4TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79430-5302
Practice Address - Country:US
Practice Address - Phone:806-743-3659
Practice Address - Fax:806-743-3143
Is Sole Proprietor?:No
Enumeration Date:2017-05-23
Last Update Date:2024-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10060883207R00000X
TXV0174207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine