Provider Demographics
NPI:1033796099
Name:HORBACZEWSKI, ALYSIA SHANNON (MD)
Entity type:Individual
Prefix:
First Name:ALYSIA
Middle Name:SHANNON
Last Name:HORBACZEWSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALYSIA
Other - Middle Name:SHANNON
Other - Last Name:HALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:230 E SYCAMORE ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75090-5012
Mailing Address - Country:US
Mailing Address - Phone:903-202-2900
Mailing Address - Fax:
Practice Address - Street 1:230 E SYCAMORE ST STE 100
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-5012
Practice Address - Country:US
Practice Address - Phone:903-202-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-25
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCHORB-ZXTY4O208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics