Healthcare Provider Details

I. General information

NPI: 1700895018
Provider Name (Legal Business Name): SHANNA TREANOR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 12/01/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5101 COMMERCE DR SUITE 101
BAKERSFIELD CA
93309-0411
US

IV. Provider business mailing address

5101 COMMERCE DR SUITE 101
BAKERSFIELD CA
93309-0411
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-3756
  • Fax: 661-327-2332
Mailing address:
  • Phone: 661-327-3756
  • Fax: 661-327-2332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA70557
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberA70557
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA70557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: