Provider Demographics
NPI:1487727202
Name:MASNERI, SHANNON MARIE (DO)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MARIE
Last Name:MASNERI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:6412 PEPPERMILL DR
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:NC
Mailing Address - Zip Code:27310-9803
Mailing Address - Country:US
Mailing Address - Phone:910-992-1457
Mailing Address - Fax:
Practice Address - Street 1:1510 NC HIGHWAY 68 N # 1510
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:NC
Practice Address - Zip Code:27310-9733
Practice Address - Country:US
Practice Address - Phone:336-644-0111
Practice Address - Fax:336-268-3119
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS1019207Q00000X
NC2014-01987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine