Healthcare Provider Details

I. General information

NPI: 1225098353
Provider Name (Legal Business Name): SHELLEY L ZAUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 RAHNCLIFF CT
EAGAN MN
55122-3469
US

IV. Provider business mailing address

2000 RAHNCLIFF CT
EAGAN MN
55122-3469
US

V. Phone/Fax

Practice location:
  • Phone: 612-515-8809
  • Fax: 833-973-3526
Mailing address:
  • Phone: 612-515-8809
  • Fax: 833-973-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number38944
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38944
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: