Provider Demographics
NPI:1972595437
Name:SHKEDY, CLIVE I (MD)
Entity type:Individual
Prefix:DR
First Name:CLIVE
Middle Name:I
Last Name:SHKEDY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16675 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-2344
Mailing Address - Country:US
Mailing Address - Phone:281-274-7800
Mailing Address - Fax:
Practice Address - Street 1:16675 SOUTHWEST FWY
Practice Address - Street 2:SUITE 105
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2344
Practice Address - Country:US
Practice Address - Phone:281-274-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2016-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ71912085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038116202Medicaid
TX038116203Medicaid
TX8BN488OtherBCBS
TX038116201Medicaid
TX038116205Medicaid
TX80R279OtherBLUE CROSS
TX038116204Medicaid
TXP00816423OtherMEDICARE RAILROAD
TX8BN488OtherBCBS
TXF86908Medicare UPIN
TX038116204Medicaid
TX038116205Medicaid
TX8BN488OtherBCBS
TXP00816423OtherMEDICARE RAILROAD