Individual
SHONDA BANEGAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D. O.
Contact information
Practice address
5012 S US HIGHWAY 75 STE 110, DENISON, TX 75020-4596
(903) 416-6419
(903) 416-6484
Mailing address
5012 S US HIGHWAY 75 STE 110, DENISON, TX 75020-4596
(903) 416-6419
(903) 416-6484
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
5101016869
MI
2086S0129X
Vascular Surgery Physician
6136
AZ
2086S0129X
Vascular Surgery Physician
Primary
R7657
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
348242401
—
TX
Enumeration date
11/14/2007
Last updated
07/25/2023
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