MEDICARE: MRS. MEGAN BLAIR KENNEDY SHEDDEN P.A.C.

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	363AS0400X	Surgical Physician Assistant	PA03105	TX

General Provider Information

NPI Number	:	1922107556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MEGAN BLAIR KENNEDY SHEDDEN P.A.C.

Provider Business Mailing Address
First Line	:	9200 NEW TRAILS DRIVE
Second Line	:	SUITE 100
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-5257
Country	:	US
Telephone Number	:	281-364-9509
Fax Number	:	281-364-0984

Provider Business Practice Location Address
First Line	:	9200 NEW TRAILS DRIVE
Second Line	:	SUITE 100
City	:	THE WOODLANDS
State	:	TX
Zip	:	77381-5257
Country	:	US
Telephone Number	:	281-364-9509
Fax Number	:	281-364-9509

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

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	04/11/2011

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