Provider Demographics
NPI:1760234066
Name:DERALEAU, PEYTON SHEA (DVM)
Entity Type:Individual
Prefix:MRS
First Name:PEYTON
Middle Name:SHEA
Last Name:DERALEAU
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:MS
Other - First Name:PEYTON
Other - Middle Name:SHEA
Other - Last Name:FLEMINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DVM
Mailing Address - Street 1:139 COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-6212
Mailing Address - Country:US
Mailing Address - Phone:405-564-2772
Mailing Address - Fax:
Practice Address - Street 1:3141 FM 66
Practice Address - Street 2:
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75167-8407
Practice Address - Country:US
Practice Address - Phone:972-937-1120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17731174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist