Individual
MS. DIANE MERRIL SHAKTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
150 SETTLEMENT DR STE E, BASTROP, TX 78602-9662
(512) 303-3963
(512) 303-6366
Mailing address
1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
(512) 255-1720
(512) 244-8371
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
E6615
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
TX
Enumeration date
01/18/2007
Last updated
07/08/2007
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