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General NPI Number Information
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NPI Number | 1114382751
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Entity Type | Organization
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Legal Business Name | SHELLEEN E DENNO MD INC.
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Dates
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Enumeration Date | 12/28/2015
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 2285 OLIVET LN
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City | SANTA ROSA
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State | CA
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Zip | 95401-3860
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Country | US
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Telephone | 707-280-4039
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Fax | 707-542-1039
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Provider Business Mailing Address
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Address Line | 2285 OLIVET LN
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City | SANTA ROSA
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State | CA
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Zip | 95401-3860
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Country | US
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Telephone | 707-280-4039
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Fax | 707-542-1039
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Authorized Official
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Title or Position | PRESIDENT
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Name | SHELLEEN E DENNO
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Credential | MD
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Telephone | 707-280-4039
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A50098
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License Number State | CA
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