Healthcare Provider Details

I. General information

NPI: 1437236163
Provider Name (Legal Business Name): SHANNON LEE MCCUNE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON LEE FINK M.D.

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 TELEGRAPH AVE STE 130
BERKELEY CA
94705-1159
US

IV. Provider business mailing address

2850 TELEGRAPH AVE STE 130
BERKELEY CA
94705-1159
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8110
  • Fax: 510-843-0804
Mailing address:
  • Phone: 510-204-8110
  • Fax: 510-843-0804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA65481
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: