Basic Information
| Provider Information | |||||||||
| NPI: | 1740476035 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHETTY | ||||||||
| FirstName: | MANJUNATH | ||||||||
| MiddleName: | MOHAN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3215 S PEMBERTON CIRCLE DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770254331 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134170254 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 11799 BEECHNUT ST STE A | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770724116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2815757246 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2007 | ||||||||
| LastUpdateDate: | 02/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N9297 | TX | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | N9297 | TX | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.