Healthcare Provider Details

I. General information

NPI: 1679418263
Provider Name (Legal Business Name): DEMERTRIA SHONDRAYA COLLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 GRANTLAND CIRCLE
FT. WORTH TX
76112
US

IV. Provider business mailing address

10032 PYRITE DR
FT WORTH TX
76131-4345
US

V. Phone/Fax

Practice location:
  • Phone: 469-799-6199
  • Fax:
Mailing address:
  • Phone: 469-799-6199
  • Fax: 425-569-2236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number1683241
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2082S0105X
TaxonomySurgery of the Hand (Plastic Surgery) Physician
License Number1683241
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: