Provider Demographics
NPI:1104634633
Name:MOMANYI, SHEM OMWANSA
Entity type:Individual
Prefix:
First Name:SHEM
Middle Name:OMWANSA
Last Name:MOMANYI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 S PEEK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77407-1741
Mailing Address - Country:US
Mailing Address - Phone:832-535-2770
Mailing Address - Fax:
Practice Address - Street 1:6902 S PEEK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77407-1741
Practice Address - Country:US
Practice Address - Phone:832-535-2770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-30
Last Update Date:2024-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183610363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health