Healthcare Provider Details

I. General information

NPI: 1699161356
Provider Name (Legal Business Name): SHANE PATRICK SWEENEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2015
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E RIDGE RD
MCALLEN TX
78503-1847
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
FORT SAM HOUSTON TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 956-632-6000
  • Fax: 956-632-6641
Mailing address:
  • Phone: 210-916-4224
  • Fax: 210-916-3235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number0101261309
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberT4472
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: