Provider Demographics
NPI:1487459889
Name:MATLOCK, SHAUNDRALYN ALESE (FNP)
Entity type:Individual
Prefix:
First Name:SHAUNDRALYN
Middle Name:ALESE
Last Name:MATLOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6214 GALLANT FOREST DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77088-2311
Mailing Address - Country:US
Mailing Address - Phone:901-634-6041
Mailing Address - Fax:
Practice Address - Street 1:5535 MEMORIAL DR STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8023
Practice Address - Country:US
Practice Address - Phone:832-648-1172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1191024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily