Individual
SHADAN MANSOOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
11805 SOUTH FWY STE 201, BURLESON, TX 76028-7220
(817) 551-5312
Mailing address
PO BOX 164009, FORT WORTH, TX 76161-4009
(817) 759-7000
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
M1226
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1736241-01
—
TX
05
—
1736241-02
—
TX
01
—
8M2993
BCBS
TX
Enumeration date
05/10/2006
Last updated
02/06/2025
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