MEDICARE: DR. DAVID SHAW NILASENA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	H2645	TX

General Provider Information

NPI Number	:	1194062323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID SHAW NILASENA M.D.

Provider Business Mailing Address
First Line	:	1301 YOUNG ST
Second Line	:	ROOM 714
City	:	DALLAS
State	:	TX
Zip	:	75202-5433
Country	:	US
Telephone Number	:	214-767-4449
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 YOUNG ST
Second Line	:	ROOM 714
City	:	DALLAS
State	:	TX
Zip	:	75202-5433
Country	:	US
Telephone Number	:	214-767-4449
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2013
Last Update Date	:	01/08/2013

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