Provider Demographics
NPI:1194062323
Name:NILASENA, DAVID SHAW (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:SHAW
Last Name:NILASENA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 YOUNG ST
Mailing Address - Street 2:ROOM 714
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-5433
Mailing Address - Country:US
Mailing Address - Phone:214-767-4449
Mailing Address - Fax:
Practice Address - Street 1:1301 YOUNG ST
Practice Address - Street 2:ROOM 714
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202-5433
Practice Address - Country:US
Practice Address - Phone:214-767-4449
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH26452083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine