=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861464893
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER MCINTYRE SHEDDEN M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2006
-----------------------------------------------------
Last Update Date | 03/02/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9200 NEW TRAILS DR SUITE 100
-----------------------------------------------------
City | THE WOODLANDS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77381-5256
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-364-9509
-----------------------------------------------------
Fax | 281-364-0984
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5219 CITY BANK PKWY STE 130
-----------------------------------------------------
City | LUBBOCK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79407-3544
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-761-0333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207T00000X
-----------------------------------------------------
Taxonomy Name | Neurological Surgery Physician
-----------------------------------------------------
License Number | J1040
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------