Provider Demographics
NPI:1437214624
Name:LYN, SHAUNA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:
Last Name:LYN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N LOOP 1604 W
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1456
Mailing Address - Country:US
Mailing Address - Phone:210-595-1019
Mailing Address - Fax:210-251-3194
Practice Address - Street 1:418 N LOOP 1604 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1456
Practice Address - Country:US
Practice Address - Phone:210-595-1019
Practice Address - Fax:210-251-3194
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2019-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058616174400000X
TXK7449208800000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
No208800000XAllopathic & Osteopathic PhysiciansUrology