Provider Demographics
NPI:1003351594
Name:SEYBOLD, SHANDRIA DAPHENE (FNP)
Entity Type:Individual
Prefix:PROF
First Name:SHANDRIA
Middle Name:DAPHENE
Last Name:SEYBOLD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14855 BLANCO RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7732
Mailing Address - Country:US
Mailing Address - Phone:210-802-1133
Mailing Address - Fax:210-493-2900
Practice Address - Street 1:14855 BLANCO RD
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7732
Practice Address - Country:US
Practice Address - Phone:210-802-1133
Practice Address - Fax:210-493-2900
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXAP132729363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily