Healthcare Provider Details

I. General information

NPI: 1710385158
Provider Name (Legal Business Name): SHAYNA MANUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2014
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

512 E HIGHLAND BLVD STE 150
SAN ANTONIO TX
78210-3521
US

IV. Provider business mailing address

5009 UNIVERSITY AVE STE C
LUBBOCK TX
79413-4432
US

V. Phone/Fax

Practice location:
  • Phone: 210-207-8152
  • Fax: 210-207-2116
Mailing address:
  • Phone: 806-712-1096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP126413
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: