=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013398734
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHANNON LEIGH TOSOUNIAN D.O.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/18/2015
-----------------------------------------------------
Last Update Date | 09/12/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5405 SAUCON CREEK RD SUITE 200
-----------------------------------------------------
City | CENTER VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18034-3018
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-526-6545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4505 SAUCON CREEK RD
-----------------------------------------------------
City | CENTER VALLEY
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 18034-8481
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 484-526-6545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RG0100X
-----------------------------------------------------
Taxonomy Name | Gastroenterology Physician
-----------------------------------------------------
License Number | OS021519
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------