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General NPI Number Information
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NPI Number | 1043664998
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Entity Type | Individual
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Provider Name | SHANNON MARIA SAROKA NP
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Gender | Female
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Dates
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Enumeration Date | 04/18/2016
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Last Update Date | 11/07/2025
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Provider Practice Location Address
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Address Line | 2160 FOUNTAIN DR STE D
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City | SNELLVILLE
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State | GA
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Zip | 30078-7022
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Country | US
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Telephone | 770-982-7790
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Fax | 770-982-7795
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Provider Business Mailing Address
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Address Line | 2160 FOUNTAIN DR STE D
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City | SNELLVILLE
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State | GA
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Zip | 30078-7022
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Country | US
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Telephone | 770-982-7790
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Fax |
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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 | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | RN199433
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License Number State | GA
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