Provider Demographics
NPI:1336415686
Name:GOLDSTEIN, SHIRA (MD)
Entity Type:Individual
Prefix:
First Name:SHIRA
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIRA
Other - Middle Name:
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6410 FANNIN ST STE 230
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3002
Mailing Address - Country:US
Mailing Address - Phone:832-325-6500
Mailing Address - Fax:713-512-2203
Practice Address - Street 1:6410 FANNIN ST STE 170
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3003
Practice Address - Country:US
Practice Address - Phone:832-325-6500
Practice Address - Fax:713-512-2203
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD455040207Q00000X
TXR9217207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA523808Medicare PIN