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General NPI Number Information
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NPI Number | 1780939504
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Entity Type | Individual
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Provider Name | SHAYE LYSETTE WALSTON D.O.
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Gender | Female
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 4613 S STAPLES ST STE CD
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City | CORPUS CHRISTI
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State | TX
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Zip | 78411-2780
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Country | US
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Telephone | 361-851-0000
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Fax | 361-653-2543
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Provider Business Mailing Address
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Address Line | 2883 FM 665
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City | ROBSTOWN
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State | TX
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Zip | 78380-5951
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Country | US
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Telephone | 361-771-5257
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | P5491
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License Number State | TX
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