Provider Demographics
NPI:1083901680
Name:GASTAL, SHAWNEE WONG (AU D)
Entity Type:Individual
Prefix:DR
First Name:SHAWNEE
Middle Name:WONG
Last Name:GASTAL
Suffix:
Gender:F
Credentials:AU D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3875
Mailing Address - Country:US
Mailing Address - Phone:832-828-1800
Mailing Address - Fax:
Practice Address - Street 1:15400 SOUTHWEST FWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3875
Practice Address - Country:US
Practice Address - Phone:832-828-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80408231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist