Provider Demographics
NPI:1376200030
Name:MATSUNO, SHANNON NICHOLE (NP)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:NICHOLE
Last Name:MATSUNO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:SKOLAUT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8300 N LAMAR BLVD STE 200A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5976
Mailing Address - Country:US
Mailing Address - Phone:512-782-9312
Mailing Address - Fax:512-782-9316
Practice Address - Street 1:8300 N LAMAR BLVD STE 200A
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5976
Practice Address - Country:US
Practice Address - Phone:888-201-5112
Practice Address - Fax:512-782-9316
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX872145163W00000X
TXAP1071993363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner