Healthcare Provider Details

I. General information

NPI: 1013909811
Provider Name (Legal Business Name): SHANNON M BERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

295 POSADA LN SUITE D
TEMPLETON CA
93465-4055
US

IV. Provider business mailing address

295 POSADA LN SUITE D
TEMPLETON CA
93465-4055
US

V. Phone/Fax

Practice location:
  • Phone: 805-434-9900
  • Fax: 805-434-9933
Mailing address:
  • Phone: 805-434-9900
  • Fax: 805-434-9933

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA070193
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: