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General NPI Number Information
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NPI Number | 1528293263
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Entity Type | Individual
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Provider Name | TANEYA SHESTOPALOVA MD
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Gender | Female
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 04/14/2025
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Provider Practice Location Address
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Address Line | 301 UNIVERSITY BLVD
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City | GALVESTON
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State | TX
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Zip | 77555
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Country | US
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Telephone | 409-772-1011
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 650859 DEPT 710
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City | DALLAS
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State | TX
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Zip | 75265-0859
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Country | US
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Telephone | 409-772-2222
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 47475
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 2085N0700X
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Taxonomy Name | Neuroradiology Physician
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License Number | S0985
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | S0985
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License Number State | TX
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