Provider Demographics
NPI:1689671059
Name:DEPTA, SHAUNA W (MD)
Entity type:Individual
Prefix:
First Name:SHAUNA
Middle Name:W
Last Name:DEPTA
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7805 ODELL ST
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76182-3961
Mailing Address - Country:US
Mailing Address - Phone:951-294-1078
Mailing Address - Fax:
Practice Address - Street 1:4002 LOUETTA ROAD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77388-4405
Practice Address - Country:US
Practice Address - Phone:281-444-1770
Practice Address - Fax:281-444-4739
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4839207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX174312205Medicaid
TX174312203Medicaid
TX8CA788OtherBCBS
TX174312204Medicaid
TX174312204Medicaid
TX174312203Medicaid