Healthcare Provider Details

I. General information

NPI: 1518971142
Provider Name (Legal Business Name): SHANNON M. MCALLISTER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3810 SPRINGHURST BLVD SUITE 200
LOUISVILLE KY
40241
US

IV. Provider business mailing address

PO BOX 950132
LOUISVILLE KY
40295-0132
US

V. Phone/Fax

Practice location:
  • Phone: 502-583-1749
  • Fax: 502-329-8184
Mailing address:
  • Phone: 888-980-8992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number30431
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number30431
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: