MEDICARE: SHANNON M. RUSH DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E4271	CA

General Provider Information

NPI Number	:	1083788681
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON M. RUSH DPM

Provider Business Mailing Address
First Line	:	4626 WILLOW RD
Second Line	:	STE 200
City	:	PLEASANTON
State	:	CA
Zip	:	94588-8564
Country	:	US
Telephone Number	:	925-463-0470
Fax Number	:	844-830-3541

Provider Business Practice Location Address
First Line	:	4626 WILLOW RD
Second Line	:	STE 200
City	:	PLEASANTON
State	:	CA
Zip	:	94588-8564
Country	:	US
Telephone Number	:	925-463-0470
Fax Number	:	844-830-3541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2006
Last Update Date	:	02/27/2025

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Directions to “ SHANNON M. RUSH DPM” Practice Location

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