Doctor Name: | SHANNON MARIA SAROKA |
NPI Number: | 1043664998 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | RN199433 |
Business Practice Address: | 2160 Fountain Dr Ste D Snellville, GA - 300787022 |
Business Phone Number: | 7709827790 |
Business Fax Number: | 7709827795 |
Mailing Address: | 2160 Fountain Dr Ste D, SNELLVILLE |
State: | GA |
Postal Code: | 300787022 |
Phone Number: | 7709827790 |
Fax Number: | |
NPI Enumeration Date: | 04/18/2016 |
NPI Last Update Date: | 04/18/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LG0600X |
License Number: | RN199433 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | GA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Gerontology |
Taxonomy Definition: |