Provider Demographics
NPI:1013283407
Name:SHEHAN, MARIA LAURA (PA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:LAURA
Last Name:SHEHAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LAURA
Other - Last Name:SHEHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:321 N HIGHLAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75092-7378
Mailing Address - Country:US
Mailing Address - Phone:903-893-5141
Mailing Address - Fax:903-891-4289
Practice Address - Street 1:321 N HIGHLAND
Practice Address - Street 2:SUITE 200
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75092
Practice Address - Country:US
Practice Address - Phone:903-893-5141
Practice Address - Fax:903-891-4289
Is Sole Proprietor?:No
Enumeration Date:2012-03-29
Last Update Date:2012-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07122363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant