Provider Demographics
NPI:1760688295
Name:WALKER, SHAYNA TANISE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHAYNA
Middle Name:TANISE
Last Name:WALKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:150 VALPREDA RD
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-2973
Mailing Address - Country:US
Mailing Address - Phone:760-736-8675
Mailing Address - Fax:760-736-8642
Practice Address - Street 1:150 VALPREDA RD
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-2973
Practice Address - Country:US
Practice Address - Phone:760-736-8675
Practice Address - Fax:760-736-8642
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2011-01965207Q00000X, 2084P0800X
CAA1073932084P0800X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5920366Medicaid
NC172W0OtherBLUE CROSS BLUE SHILED OF NC
NC252985OtherMEDCOST, LLC
NC5920813Medicaid
NCNC7241AOtherMEDICARE