Provider Demographics
NPI:1003516329
Name:PINA, SHASTA HAYES
Entity Type:Individual
Prefix:MRS
First Name:SHASTA
Middle Name:HAYES
Last Name:PINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 987
Mailing Address - Street 2:
Mailing Address - City:LA FERIA
Mailing Address - State:TX
Mailing Address - Zip Code:78559-0987
Mailing Address - Country:US
Mailing Address - Phone:956-412-3269
Mailing Address - Fax:
Practice Address - Street 1:2952 BOCA CHICA BLVD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3506
Practice Address - Country:US
Practice Address - Phone:956-243-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2023-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2068857208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation