MEDICARE: DR. SHELLEY P SCHOONOVER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	93385	NM
2	208000000X	Pediatrics Physician	J0249	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790779007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLEY P SCHOONOVER MD

Provider Business Mailing Address
First Line	:	3917 WEST RD
Second Line	:	STE 128
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2275
Country	:	US
Telephone Number	:	505-662-4234
Fax Number	:	505-662-7894

Provider Business Practice Location Address
First Line	:	3917 WEST RD
Second Line	:	STE 128
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-2275
Country	:	US
Telephone Number	:	505-662-4234
Fax Number	:	505-662-7894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. SHELLEY P SCHOONOVER MD” Practice Location

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