Provider Demographics
NPI:1134230063
Name:KINCHELOE-ZAREN, SHAUNA S (MD)
Entity type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:S
Last Name:KINCHELOE-ZAREN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5283 OLD BROWNSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78405-3908
Mailing Address - Country:US
Mailing Address - Phone:361-806-5604
Mailing Address - Fax:361-806-5604
Practice Address - Street 1:5283 OLD BROWNSVILLE RD
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78405-3908
Practice Address - Country:US
Practice Address - Phone:361-806-5604
Practice Address - Fax:361-806-5604
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA061906207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA908674918AMedicaid
GA908674918BMedicaid
SCG61906Medicaid
GA908674918CMedicaid
GAP00687385OtherRAILROAD MEDICARE
GA202I083386Medicare PIN
GA511I080638Medicare PIN
GA908674918BMedicaid