Provider Demographics
NPI:1962724575
Name:REED, SHANNON RICHARD (PEDORTHIST)
Entity type:Individual
Prefix:MR
First Name:SHANNON
Middle Name:RICHARD
Last Name:REED
Suffix:
Gender:M
Credentials:PEDORTHIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 56TH ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3306
Mailing Address - Country:US
Mailing Address - Phone:916-457-2726
Mailing Address - Fax:916-457-2728
Practice Address - Street 1:719 56TH ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3306
Practice Address - Country:US
Practice Address - Phone:916-457-2726
Practice Address - Fax:916-457-2728
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPED3329174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist