Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PP0204X | Pediatric Emergency Physician | 81648 | GA |
N | 208000000X | Pediatrician | 81648 | GA |
N | 208000000X | Pediatrician | BP10043657 | TX |
N | 208000000X | Pediatrician | Q2552 | TX |
NPI | 1538429212 |
---|---|
Provider Name | Shana Godfred-Cato |
First Address | Austin, TX 78759-5785 |
Second Address | Kyle, TX 78640-6147 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/05/2012 |
Last Update Date | 14/01/2022 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
350026601 | (05) | TX |
350026602 | (05) | TX |