Healthcare Provider Details

I. General information

NPI: 1508245689
Provider Name (Legal Business Name): SHANNON CALDWELL CLEMONS GOODE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHANNON CALDWELL CLEMONS MD

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 ALHAMBRA BLVD STE 230
SACRAMENTO CA
95816-5241
US

IV. Provider business mailing address

PO BOX 255228
SACRAMENTO CA
95865-5228
US

V. Phone/Fax

Practice location:
  • Phone: 916-262-9440
  • Fax: 916-262-9445
Mailing address:
  • Phone: 800-470-0071
  • Fax: 916-854-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number323811
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number039.146919
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberC206857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: