Basic Information
| Provider Information | |||||||||
| NPI: | 1437214624 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LYN | ||||||||
| FirstName: | SHAUNA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 418 N LOOP 1604 W | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782321456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105951019 | ||||||||
| FaxNumber: | 2102513194 | ||||||||
| Practice Location | |||||||||
| Address1: | 418 N LOOP 1604 W | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782321456 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2105951019 | ||||||||
| FaxNumber: | 2102513194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 01/15/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 058616 | GA | N | Other Service Providers | Specialist | 208800000X | K7449 | TX | N | Allopathic & Osteopathic Physicians | Urology | 207Q00000X | K7449 | TX | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.