Healthcare Provider Details

I. General information

NPI: 1891869517
Provider Name (Legal Business Name): SHANNON B PAYSEUR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 06/12/2022
Certification Date: 06/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17051 DALLAS PKWY STE 250
ADDISON TX
75001-7121
US

IV. Provider business mailing address

5600 W LOVERS LN # 116-312
DALLAS TX
75209-4330
US

V. Phone/Fax

Practice location:
  • Phone: 972-685-7330
  • Fax: 469-666-1084
Mailing address:
  • Phone: 469-277-2701
  • Fax: 469-666-1084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License NumberM0858
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM0858
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: