Healthcare Provider Details

I. General information

NPI: 1932595162
Provider Name (Legal Business Name): SHANNON RAYMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2015
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

328 AVERY RD
FRANCESTOWN NH
03043-3501
US

IV. Provider business mailing address

1851 N RIVERSIDE AVE
RIALTO CA
92376-8069
US

V. Phone/Fax

Practice location:
  • Phone: 757-651-1530
  • Fax:
Mailing address:
  • Phone: 909-421-2700
  • Fax: 909-874-0826

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number010602
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number24266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: