Provider Demographics
NPI:1427012947
Name:PEVETO TOMECKO, S WINCY (MD)
Entity Type:Individual
Prefix:DR
First Name:S WINCY
Middle Name:
Last Name:PEVETO TOMECKO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHANNON
Other - Middle Name:WINCY PEVETO
Other - Last Name:TOMECKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7200 STATE HIGHWAY 161 STE 350
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-4682
Mailing Address - Country:US
Mailing Address - Phone:972-401-0700
Mailing Address - Fax:972-401-0711
Practice Address - Street 1:7200 STATE HIGHWAY 161 STE 350
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-4682
Practice Address - Country:US
Practice Address - Phone:972-401-0700
Practice Address - Fax:972-401-0711
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4092208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX159157001Medicaid
TX8A8595Medicare ID - Type Unspecified