Provider Demographics
NPI:1356567267
Name:SHELBY-NWOKEJI, AMELIA RUTH-DESIRET (MD)
Entity type:Individual
Prefix:DR
First Name:AMELIA
Middle Name:RUTH-DESIRET
Last Name:SHELBY-NWOKEJI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18114 BAYOU MEAD TRL
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3078
Mailing Address - Country:US
Mailing Address - Phone:281-852-6457
Mailing Address - Fax:281-973-9624
Practice Address - Street 1:211 HIGHLAND CROSS DR
Practice Address - Street 2:SUITE 275
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-1733
Practice Address - Country:US
Practice Address - Phone:281-784-1500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM2098207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1356567267OtherBCBSTX
TX207528501Medicaid
TX8CD039OtherBCBS TX
TX1356567267OtherTRICARE SOUTH
TX1356567267Medicare PIN
TX8L22189Medicare PIN
TXP00808350Medicare PIN