Basic Information
| Provider Information | |||||||||
| NPI: | 1730412065 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BELSHA | ||||||||
| FirstName: | JERISSA | ||||||||
| MiddleName: | P | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6769 LAKE WOODLANDS DR | ||||||||
| Address2: | SUITE E | ||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773822770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812101200 | ||||||||
| FaxNumber: | 2812101210 | ||||||||
| Practice Location | |||||||||
| Address1: | 6769 LAKE WOODLANDS DR | ||||||||
| Address2: | SUITE E | ||||||||
| City: | THE WOODLANDS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 773822770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2812101200 | ||||||||
| FaxNumber: | 2812101210 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2009 | ||||||||
| LastUpdateDate: | 12/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | N1550 | TX | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.