Provider Demographics
NPI:1194031641
Name:JACOB, SHANCY (DO)
Entity type:Individual
Prefix:
First Name:SHANCY
Middle Name:
Last Name:JACOB
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:301 UNIVERSITY BLVD
Mailing Address - Street 2:4.200 JOHN SEALY ANNEX
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77555-0562
Mailing Address - Country:US
Mailing Address - Phone:409-772-1811
Mailing Address - Fax:
Practice Address - Street 1:301 UNIVERSITY BLVD
Practice Address - Street 2:4.200 JOHN SEALY ANNEX
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0562
Practice Address - Country:US
Practice Address - Phone:409-772-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-22
Last Update Date:2015-08-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXP2010207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology