Provider Demographics
NPI:1891869517
Name:PAYSEUR, SHANNON B (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:B
Last Name:PAYSEUR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:5600 W LOVERS LN # 116-312
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75209-4330
Mailing Address - Country:US
Mailing Address - Phone:469-277-2701
Mailing Address - Fax:469-666-1084
Practice Address - Street 1:17051 DALLAS PKWY STE 250
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-7121
Practice Address - Country:US
Practice Address - Phone:972-685-7330
Practice Address - Fax:469-666-1084
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM08582083P0011X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX12529264OtherCAQH PROVIDER #
TX218958101Medicaid
TX2944264OtherUHC
TX0A4803OtherPTAN GROUP NPI
TX9815182OtherAETNA
TX8396021OtherCIGNA
TX201636201Medicaid