Provider Demographics
NPI:1659444826
Name:CHAMBERLAIN, SHAWN L (PAC)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:L
Last Name:CHAMBERLAIN
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5560 GADWALL DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-5064
Mailing Address - Country:US
Mailing Address - Phone:817-808-5180
Mailing Address - Fax:
Practice Address - Street 1:5560 GADWALL DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-5064
Practice Address - Country:US
Practice Address - Phone:817-808-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS30442Medicare UPIN