Provider Demographics
NPI:1124433719
Name:COSTINETT, SHAUNA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:MARIE
Last Name:COSTINETT
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:SHAUNA
Other - Middle Name:MARIE
Other - Last Name:SHEPPARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1750 WEST HARRISON STREET
Mailing Address - Street 2:GENERAL SURGERY OFFICE
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612
Mailing Address - Country:US
Mailing Address - Phone:312-942-6510
Mailing Address - Fax:312-942-2867
Practice Address - Street 1:6565 N CHARLES ST STE 501
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-5802
Practice Address - Country:US
Practice Address - Phone:443-849-3779
Practice Address - Fax:443-849-3767
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125065618208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery