Healthcare Provider Details

I. General information

NPI: 1881670438
Provider Name (Legal Business Name): SHANNON T SUO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 11/12/2025
Certification Date: 11/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2365 IRON POINT RD STE 210
FOLSOM CA
95630-8713
US

IV. Provider business mailing address

2365 IRON POINT RD STE 210
FOLSOM CA
95630-8713
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax:
Mailing address:
  • Phone: 925-282-1778
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA69478
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA69478
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: