Provider Demographics
NPI:1952339269
Name:MERRITT, SHIRLEY GAY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:GAY
Last Name:MERRITT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:CLARK
Other - Last Name:MERRITT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14142 IVY BLUFF COURT
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062
Mailing Address - Country:US
Mailing Address - Phone:830-755-4464
Mailing Address - Fax:830-755-4684
Practice Address - Street 1:14142 IVY BLUFF COURT
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062
Practice Address - Country:US
Practice Address - Phone:830-455-4464
Practice Address - Fax:830-755-4684
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4553174400000X, 2084P0800X
NC2013-009132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A3545OtherPTAN
0A3545OtherPTAN
TXE83479Medicare UPIN