Provider Demographics
NPI:1750043386
Name:SEVERNS, DANEILA SHANTEL (PA-C)
Entity Type:Individual
Prefix:
First Name:DANEILA
Middle Name:SHANTEL
Last Name:SEVERNS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6122 BROADWAY ST STE 100
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7804
Mailing Address - Country:US
Mailing Address - Phone:713-461-2915
Mailing Address - Fax:713-474-8131
Practice Address - Street 1:6122 BROADWAY ST STE 100
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7804
Practice Address - Country:US
Practice Address - Phone:713-461-2915
Practice Address - Fax:713-474-8131
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15031363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical