Healthcare Provider Details

I. General information

NPI: 1821432584
Provider Name (Legal Business Name): SHAUNA BUTLER NORMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 GASTON PLACE DR STE C
AUSTIN TX
78723-2658
US

IV. Provider business mailing address

1928 GASTON PLACE DR STE C
AUSTIN TX
78723-2658
US

V. Phone/Fax

Practice location:
  • Phone: 512-600-2234
  • Fax: 512-600-2236
Mailing address:
  • Phone: 512-600-2234
  • Fax: 512-600-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080S0010X
TaxonomyPediatric Sports Medicine Physician
License NumberS9854
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberS9854
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: