Provider Demographics
NPI:1124087317
Name:SHANNON, KAREN WANG (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:WANG
Last Name:SHANNON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8976 SW 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-4962
Mailing Address - Country:US
Mailing Address - Phone:352-219-8104
Mailing Address - Fax:
Practice Address - Street 1:812 NW 57TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-6414
Practice Address - Country:US
Practice Address - Phone:352-519-5420
Practice Address - Fax:352-333-6249
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME81339207QA0505X, 207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053127800Medicaid
FLE75962Medicare UPIN
FL053127800Medicaid
FL51758ZMedicare PIN
FL51758YMedicare PIN