Provider Demographics
NPI:1114590510
Name:SUMESH, SHANET (APRN)
Entity type:Individual
Prefix:
First Name:SHANET
Middle Name:
Last Name:SUMESH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:SHANET
Other - Middle Name:
Other - Last Name:MATHEW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 4439
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77210-4439
Mailing Address - Country:US
Mailing Address - Phone:713-792-2991
Mailing Address - Fax:
Practice Address - Street 1:8244 ANTOINE DR STE K
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77088-2531
Practice Address - Country:US
Practice Address - Phone:281-925-7547
Practice Address - Fax:281-492-0557
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-22
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX795537163WX0200X, 363LS0200X
TX1152696363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163WX0200XNursing Service ProvidersRegistered NurseOncologyGroup - Single Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchoolGroup - Single Specialty