Provider Demographics
NPI:1902367543
Name:MASHNI, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MASHNI
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 1:502 N VALLEY PKWY STE 2
Mailing Address - Street 2:
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-3437
Mailing Address - Country:US
Mailing Address - Phone:972-316-0902
Mailing Address - Fax:972-316-1161
Practice Address - Street 1:502 N VALLEY PKWY STE 2
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-3437
Practice Address - Country:US
Practice Address - Phone:972-316-0902
Practice Address - Fax:972-316-1161
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-27
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1113213ES0103X
TX3148213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery