Provider Demographics
NPI:1578897138
Name:SHAHAN, JAIME LYNN MAST (PA-C)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:LYNN MAST
Last Name:SHAHAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:LYNN
Other - Last Name:MAST
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:214-645-4673
Mailing Address - Fax:214-648-7016
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:214-645-4673
Practice Address - Fax:214-648-7016
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA200319363A00000X
TXPA10486363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant