MEDICARE: DR. SHAUNA S KINCHELOE-ZAREN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	061906	GA
2	207Q00000X	Family Medicine Physician	S2817	TX

General Provider Information

NPI Number	:	1134230063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHAUNA S KINCHELOE-ZAREN M.D.

Provider Business Mailing Address
First Line	:	2216 PADRE BLVD STE 525
Second Line	:
City	:	SOUTH PADRE ISLAND
State	:	TX
Zip	:	78597-0204
Country	:	US
Telephone Number	:	956-525-3225
Fax Number	:

Provider Business Practice Location Address
First Line	:	5800 PADRE BLVD
Second Line	:
City	:	SOUTH PADRE ISLAND
State	:	TX
Zip	:	78597-7613
Country	:	US
Telephone Number	:	956-525-3225
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/05/2026

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