Provider Demographics
NPI:1811169501
Name:RAZA, SHAKEEL (MD)
Entity type:Individual
Prefix:
First Name:SHAKEEL
Middle Name:
Last Name:RAZA
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 1:12234 SHADOW CREEK PKWY
Mailing Address - Street 2:BLDG # 4, 4104
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7330
Mailing Address - Country:US
Mailing Address - Phone:713-429-5325
Mailing Address - Fax:
Practice Address - Street 1:12234 SHADOW CREEK PKWY
Practice Address - Street 2:BLDG # 4, 4104
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7330
Practice Address - Country:US
Practice Address - Phone:713-429-5325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-02
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP27672084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB164622Medicare PIN