Provider Demographics
NPI:1528075132
Name:MUNOZ, SHANAN BRINSON (MD)
Entity type:Individual
Prefix:
First Name:SHANAN
Middle Name:BRINSON
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANAN
Other - Middle Name:BRINSON
Other - Last Name:MYEB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 845347
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-5347
Mailing Address - Country:US
Mailing Address - Phone:972-867-3535
Mailing Address - Fax:972-867-3530
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-7201
Practice Address - Country:US
Practice Address - Phone:972-867-3535
Practice Address - Fax:972-867-3530
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG83102084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116918704Medicaid
8D0671Medicare ID - Type Unspecified
TX116918704Medicaid