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General NPI Number Information
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NPI Number | 1033227483
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Entity Type | Individual
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Provider Name | MARYELLEN KATHRYN SHANNON MD
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Gender | Female
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Dates
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Enumeration Date | 08/27/2006
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Last Update Date | 01/02/2015
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Provider Practice Location Address
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Address Line | 6 HUGHES STE 100
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City | IRVINE
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State | CA
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Zip | 92618-2059
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Country | US
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Telephone | 949-680-1880
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Fax | 949-680-1881
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Provider Business Mailing Address
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Address Line | 6 HUGHES STE 100
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City | IRVINE
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State | CA
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Zip | 92618-2059
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Country | US
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Telephone | 949-680-1880
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Fax | 949-680-1881
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | AZ19717
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License Number State | AZ
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