Healthcare Provider Details

I. General information

NPI: 1295362820
Provider Name (Legal Business Name): MATTHEW CLAIBOURNE SHONNARD MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 E OVERLAND RD
MERIDIAN ID
83642-6757
US

IV. Provider business mailing address

PO BOX 1128
BOISE ID
83701-1128
US

V. Phone/Fax

Practice location:
  • Phone: 775-327-5174
  • Fax:
Mailing address:
  • Phone: 208-884-1333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number9971149
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: