Provider Demographics
NPI:1497266290
Name:JIMENEZ, SHAUNA MARIE (LSA)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:MARIE
Last Name:JIMENEZ
Suffix:
Gender:F
Credentials:LSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 FOREST BEND RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-2089
Mailing Address - Country:US
Mailing Address - Phone:469-476-7342
Mailing Address - Fax:
Practice Address - Street 1:4001 FOREST BEND RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-2089
Practice Address - Country:US
Practice Address - Phone:469-476-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-19
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX178378208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery