Healthcare Provider Details

I. General information

NPI: 1437214624
Provider Name (Legal Business Name): SHAUNA LYN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 01/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N LOOP 1604 W
SAN ANTONIO TX
78232-1456
US

IV. Provider business mailing address

418 N LOOP 1604 W
SAN ANTONIO TX
78232-1456
US

V. Phone/Fax

Practice location:
  • Phone: 210-595-1019
  • Fax: 210-251-3194
Mailing address:
  • Phone: 210-595-1019
  • Fax: 210-251-3194

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number058616
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberK7449
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK7449
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: