Provider Demographics
NPI:1568525434
Name:TRELFORD, SHANNA MARIE (RN PMHNP)
Entity Type:Individual
Prefix:
First Name:SHANNA
Middle Name:MARIE
Last Name:TRELFORD
Suffix:
Gender:F
Credentials:RN PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N STEMMONS FWY STE 151
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75207-2111
Mailing Address - Country:US
Mailing Address - Phone:888-905-0595
Mailing Address - Fax:
Practice Address - Street 1:2600 N STEMMONS FWY
Practice Address - Street 2:SUITE 151
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75207-2113
Practice Address - Country:US
Practice Address - Phone:888-905-0595
Practice Address - Fax:214-459-2530
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2013-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX570937363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP81442Medicare UPIN
TX8A4098Medicare ID - Type Unspecified