MEDICARE: SHEY KYLE DITTO DO

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	208600000X	Surgery Physician	Q7861	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	Q7861	OTHER	TX	MEDICAL LICENSE

General Provider Information

NPI Number	:	1316387061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHEY KYLE DITTO DO

Provider Business Mailing Address
First Line	:	11615 ANGUS RD STE 106
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4064
Country	:	US
Telephone Number	:	512-436-9986
Fax Number	:	512-436-8295

Provider Business Practice Location Address
First Line	:	11615 ANGUS RD STE 106
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78759-4064
Country	:	US
Telephone Number	:	512-436-9986
Fax Number	:	512-436-8295

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

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	02/06/2026

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Directions to “ SHEY KYLE DITTO DO” Practice Location

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