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Individual
SHANDA HALEY BLACKMON
Active
Individual
SHANDA HALEY BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D., M.P.H.
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
58299
MN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
L6794
TX
Other
Enumeration date
06/20/2006
Last updated
09/23/2025
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