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General NPI Number Information
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NPI Number | 1285251983
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Entity Type | Individual
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Provider Name | SHANNON EJIOFOR DO
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Gender | Female
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Dates
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Enumeration Date | 06/29/2020
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 4801 ALBERTA AVE
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City | EL PASO
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State | TX
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Zip | 79905-2707
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Country | US
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Telephone | 915-215-5200
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Fax | 915-215-8640
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Provider Business Mailing Address
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Address Line | 1201 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63104-1016
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Country | US
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Telephone | 314-257-8000
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 2020018976
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | W0562
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | 2023020723
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License Number State | MO
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