MEDICARE: DR. SHANNON MARIE MCCLOSKEY 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	330589	LA
2	207VM0101X	Maternal & Fetal Medicine Physician	W0227	TX

General Provider Information

NPI Number	:	1740785443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON MARIE MCCLOSKEY MD

Provider Business Mailing Address
First Line	:	23530 KINGSLAND BLVD STE 204
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-7466
Country	:	US
Telephone Number	:	832-913-1702
Fax Number	:

Provider Business Practice Location Address
First Line	:	23530 KINGSLAND BLVD STE 204
Second Line	:
City	:	KATY
State	:	TX
Zip	:	77494-7466
Country	:	US
Telephone Number	:	832-913-1702
Fax Number	:

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

Provider Enumeration Date	:	03/26/2018
Last Update Date	:	09/27/2025

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