Basic Information
| Provider Information | |||||||||
| NPI: | 1871093161 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHITTU | ||||||||
| FirstName: | SABIAT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 W SAM HOUSTON PKWY N | ||||||||
| Address2: | STE 220 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770418224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134027824 | ||||||||
| FaxNumber: | 7135700196 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 W SAM HOUSTON PKWY N | ||||||||
| Address2: | STE 220 | ||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770418224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134027824 | ||||||||
| FaxNumber: | 7135700196 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2018 | ||||||||
| LastUpdateDate: | 08/17/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F02180043 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | AP136658 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.