Provider Demographics
NPI:1700812179
Name:HUSAIN, SHAISTA A (MD, FACS)
Entity Type:Individual
Prefix:DR
First Name:SHAISTA
Middle Name:A
Last Name:HUSAIN
Suffix:
Gender:F
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10021 MAIN ST STE B1
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5253
Mailing Address - Country:US
Mailing Address - Phone:832-366-1477
Mailing Address - Fax:832-366-1479
Practice Address - Street 1:10021 MAIN ST STE B1
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5253
Practice Address - Country:US
Practice Address - Phone:832-366-1477
Practice Address - Fax:832-366-1479
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ0534207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AJ345OtherBCBSTX
TXP00141193OtherRRMEDICARE
TX039714302Medicaid
TXP00141193OtherRRMEDICARE
TX8658B6Medicare PIN