Provider Demographics
NPI:1518940808
Name:TASSONE, SHAWN ANTHONY (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:ANTHONY
Last Name:TASSONE
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:505 W LOUIS HENNA BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-1701
Mailing Address - Country:US
Mailing Address - Phone:512-956-0296
Mailing Address - Fax:512-777-4527
Practice Address - Street 1:505 W LOUIS HENNA BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-1701
Practice Address - Country:US
Practice Address - Phone:512-956-0296
Practice Address - Fax:512-777-4527
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ29157207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
319215YL2RMedicare PIN
AZ637788Medicaid
AZG73143Medicare UPIN