MEDICARE: DR. SHANNON B PAYSEUR 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	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician	M0858	TX
2	207Q00000X	Family Medicine Physician	M0858	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12529264	OTHER	TX	CAQH PROVIDER #
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891869517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHANNON B PAYSEUR MD

Provider Business Mailing Address
First Line	:	5600 W LOVERS LN # 116-312
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75209-4330
Country	:	US
Telephone Number	:	469-277-2701
Fax Number	:	469-666-1084

Provider Business Practice Location Address
First Line	:	17051 DALLAS PKWY STE 250
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-7121
Country	:	US
Telephone Number	:	972-685-7330
Fax Number	:	469-666-1084

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

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	06/12/2022

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