Email received from:  Daniel.McAneny@superiorhealthplan.com   Sub :   Credentialing Request; Shametria Tann 1124615612  Good Morning,  We received your credentialing application for Shametria Tann; however, we did not receive all of the documentation necessary to complete the credentialing process.  Please submit the information marked below:                      Completed Conflict of Interest Disclosure form (“I do” or “I do not” must be checked and all forms must be signed and dated by provider even if not applicable)                         Completed Disclosure of Prior Contracts form (“Yes” or “No” must be checked and all forms must be signed and dated by provider even if not applicable)     You may fax or email the requested information to the contact information listed below.     Fax: 866-702-4831                Phone: 1-800-820-5686  Warm Regards,  Daniel McAneny Credentialing  Specialist I Pronouns: He/Him/His     Superior HealthPlan 5900 E. Ben White Blvd Austin, TX 78741  Direct 1-800-218-7453 Ext 42175 Fax: 1-866-702-4831 Daniel.mcaneny@SuperiorHealthPlan.com | SuperiorHealthPlan.com