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General NPI Number Information
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NPI Number | 1508091711
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Entity Type | Individual
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Provider Name | SHANNON EASTON-CARR MD
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Gender | Female
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Dates
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Enumeration Date | 05/18/2009
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 2102 EDSEL AVE
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City | MODESTO
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State | CA
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Zip | 95350-2819
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Country | US
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Telephone | 805-762-4739
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Fax | 888-462-8045
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Provider Business Mailing Address
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Address Line | 1241 JOHNSON AVE # 313
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93401-3306
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Country | US
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Telephone | 805-762-4739
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Fax | 888-462-8045
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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 | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | A111411
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A111411
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License Number State | CA
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