Provider Demographics
NPI:1619754983
Name:COLEMAN, SHON
Entity Type:Individual
Prefix:
First Name:SHON
Middle Name:
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3939 US HIGHWAY 80 E
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-3359
Mailing Address - Country:US
Mailing Address - Phone:972-373-4932
Mailing Address - Fax:318-706-1060
Practice Address - Street 1:3939 US HIGHWAY 80 E
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-3359
Practice Address - Country:US
Practice Address - Phone:972-373-4936
Practice Address - Fax:318-706-1060
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management