Provider Demographics
NPI:1215935051
Name:SHONKA, PAUL RICHARD (DPM)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:RICHARD
Last Name:SHONKA
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3536 MENDOCINO AVE
Mailing Address - Street 2:STE 200
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-3634
Mailing Address - Country:US
Mailing Address - Phone:707-525-6485
Mailing Address - Fax:707-568-5942
Practice Address - Street 1:3536 MENDOCINO AVE
Practice Address - Street 2:STE 300
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-3634
Practice Address - Country:US
Practice Address - Phone:707-575-6033
Practice Address - Fax:707-568-5942
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2738213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E27380OtherBLUE SHIELD OF CALIFORNIA
CA480029370OtherRAILROAD MEDICARE
CA000E27380Medicaid
CAAY497ZMedicare PIN
CA480029370OtherRAILROAD MEDICARE