Healthcare Provider Details

I. General information

NPI: 1235752098
Provider Name (Legal Business Name): SHANNON CORBITT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2020
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 STOCKTON BLVD
SACRAMENTO CA
95817-2215
US

IV. Provider business mailing address

4610 X ST STE 4202
SACRAMENTO CA
95817-2200
US

V. Phone/Fax

Practice location:
  • Phone: 916-453-2191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA208016
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: