MEDICARE: DIANA LYNN SHANLEY

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	2085R0202X	Diagnostic Radiology Physician	587233	MN

General Provider Information

NPI Number	:	1417814112
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANA LYNN SHANLEY

Provider Business Mailing Address
First Line	:	615 SNELLING AVE N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1806
Country	:	US
Telephone Number	:	651-214-8850
Fax Number	:	651-214-8850

Provider Business Practice Location Address
First Line	:	615 SNELLING AVE N
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55104-1806
Country	:	US
Telephone Number	:	651-214-8850
Fax Number	:	651-214-8850

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

Provider Enumeration Date	:	01/06/2026
Last Update Date	:	01/06/2026

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Directions to “ DIANA LYNN SHANLEY ” Practice Location

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