Provider Demographics
NPI:1992349914
Name:HAGAN-SHOCK, TEASIA SHIKELIA
Entity type:Individual
Prefix:MRS
First Name:TEASIA
Middle Name:SHIKELIA
Last Name:HAGAN-SHOCK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5527 IRISH HILL DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-3519
Mailing Address - Country:US
Mailing Address - Phone:832-542-3954
Mailing Address - Fax:
Practice Address - Street 1:5527 IRISH HILL DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-3519
Practice Address - Country:US
Practice Address - Phone:832-542-3954
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLLC6962347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle