Provider Demographics
NPI:1588774012
Name:TRIVEDI, SHILPA B (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHILPA
Middle Name:B
Last Name:TRIVEDI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 R V MAYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-5648
Mailing Address - Country:US
Mailing Address - Phone:281-451-8112
Mailing Address - Fax:
Practice Address - Street 1:1415 NORTH LOOP W STE 616
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-2278
Practice Address - Country:US
Practice Address - Phone:281-451-8112
Practice Address - Fax:855-271-3371
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36163103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX096012206Medicaid
TX096012208Medicaid
TXTXB165656OtherMEDICARE PTAN
TX096012203Medicaid