MEDICARE: SHAUNA W DEPTA MD

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	207V00000X	Obstetrics & Gynecology Physician	L4839	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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	8CA788	OTHER	TX	BCBS
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689671059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAUNA W DEPTA MD

Provider Business Mailing Address
First Line	:	7805 ODELL ST
Second Line	:
City	:	NORTH RICHLAND HILLS
State	:	TX
Zip	:	76182-3961
Country	:	US
Telephone Number	:	951-294-1078
Fax Number	:

Provider Business Practice Location Address
First Line	:	4002 LOUETTA ROAD
Second Line	:
City	:	SPRING
State	:	TX
Zip	:	77388-4405
Country	:	US
Telephone Number	:	281-444-1770
Fax Number	:	281-444-4739

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	03/27/2025

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Directions to “ SHAUNA W DEPTA MD” Practice Location

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