Provider Demographics
NPI:1750043386
Name:SEVERNS, DANEILA SHANTEL (PA-C)
Entity type:Individual
Prefix:
First Name:DANEILA
Middle Name:SHANTEL
Last Name:SEVERNS
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22999 HWY 59 N STE 405
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-4441
Mailing Address - Country:US
Mailing Address - Phone:281-571-7508
Mailing Address - Fax:281-571-7512
Practice Address - Street 1:22999 HWY 59 N STE 405
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-4441
Practice Address - Country:US
Practice Address - Phone:281-571-7508
Practice Address - Fax:281-571-7512
Is Sole Proprietor?:No
Enumeration Date:2021-10-11
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA15031363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical