Provider Demographics
NPI:1386134633
Name:BURDEAUX, SHAYNA (DO)
Entity type:Individual
Prefix:
First Name:SHAYNA
Middle Name:
Last Name:BURDEAUX
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 NACOGDOCHES ST STE 280
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75766-2444
Mailing Address - Country:US
Mailing Address - Phone:903-541-5396
Mailing Address - Fax:903-541-5470
Practice Address - Street 1:203 NACOGDOCHES ST STE 280
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:TX
Practice Address - Zip Code:75766-2444
Practice Address - Country:US
Practice Address - Phone:903-541-5396
Practice Address - Fax:903-541-5470
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-12
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXT7177207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology