Individual
SHELLY SIACA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
113 W GREEN ST STE 100, SAGINAW, TX 76179-1629
(682) 234-7916
Mailing address
113 W GREEN ST STE 100, SAGINAW, TX 76179-1629
(682) 234-7916
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
1006201
TX
1744P3200X
Prosthetics Case Management
—
—
246Z00000X
Other Specialist/Technologist
Primary
1006201
TX
Other
Enumeration date
09/18/2018
Last updated
02/15/2024
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