Provider Demographics
NPI:1578662292
Name:NESBITT, SHAWNA DENISE (MD MS)
Entity Type:Individual
Prefix:MRS
First Name:SHAWNA
Middle Name:DENISE
Last Name:NESBITT
Suffix:
Gender:F
Credentials:MD MS
Other - Prefix:
Other - First Name:SHAWNA
Other - Middle Name:DENISE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:214-645-2888
Mailing Address - Fax:214-648-3063
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7208
Practice Address - Country:US
Practice Address - Phone:214-645-2888
Practice Address - Fax:214-648-3063
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4077207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F31667Medicare UPIN
8652B4Medicare ID - Type Unspecified