Provider Demographics
NPI:1477679926
Name:SHAHIN, ERIC J (PA)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:J
Last Name:SHAHIN
Suffix:
Gender:M
Credentials:PA
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 220749
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75320-0001
Mailing Address - Country:US
Mailing Address - Phone:214-947-8933
Mailing Address - Fax:
Practice Address - Street 1:221 W. COLORDAO BLVD.
Practice Address - Street 2:#925
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-0001
Practice Address - Country:US
Practice Address - Phone:214-947-8933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02495363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX202117204Medicaid
TX202117206Medicaid
TX202117205Medicaid
TX202117205Medicaid