Healthcare Provider Details

I. General information

NPI: 1083788681
Provider Name (Legal Business Name): SHANNON M. RUSH DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2006
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4626 WILLOW RD STE 200
PLEASANTON CA
94588-8564
US

IV. Provider business mailing address

4626 WILLOW RD STE 200
PLEASANTON CA
94588-8564
US

V. Phone/Fax

Practice location:
  • Phone: 925-463-0470
  • Fax: 844-830-3541
Mailing address:
  • Phone: 925-463-0470
  • Fax: 844-830-3541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE4271
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: