Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP132729 | TX |
NPI | 1003351594 |
---|---|
Provider Name | Prof. Shandria Daphene Seybold |
First Address | San Antonio, TX 78216-7732 |
Second Address | San Antonio, TX 78216-7732 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2016 |
Last Update Date | 20/12/2016 |