Provider Demographics
NPI:1386610905
Name:SEKULA-GIBBS, SHELLEY A (MD)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:A
Last Name:SEKULA-GIBBS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17300 EL CAMINO REAL
Mailing Address - Street 2:STE. 103
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-2715
Mailing Address - Country:US
Mailing Address - Phone:281-480-7546
Mailing Address - Fax:
Practice Address - Street 1:17300 EL CAMINO REAL
Practice Address - Street 2:STE. 103
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-2715
Practice Address - Country:US
Practice Address - Phone:281-480-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-23
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2838207N00000X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC21606Medicare UPIN
TX8D1057Medicare PIN