Provider Demographics
NPI:1679620793
Name:MADISON, SHAWN
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:
Last Name:MADISON
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 1:6046 FM 2920 RD
Mailing Address - Street 2:SUITE 114
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-2542
Mailing Address - Country:US
Mailing Address - Phone:832-717-7917
Mailing Address - Fax:
Practice Address - Street 1:21638 SUNRISE BROOK LN
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3728
Practice Address - Country:US
Practice Address - Phone:832-717-7917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health