Healthcare Provider Details

I. General information

NPI: 1679739502
Provider Name (Legal Business Name): SHONA KAY RABON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 04/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 BARBARA JORDAN BLVD SUITE #200
AUSTIN TX
78723-3077
US

IV. Provider business mailing address

1301 BARBARA JORDAN BLVD SUITE #200
AUSTIN TX
78723-3077
US

V. Phone/Fax

Practice location:
  • Phone: 512-628-1830
  • Fax: 512-628-1831
Mailing address:
  • Phone: 512-628-1830
  • Fax: 512-628-1831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number125050822
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberN2256
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: