| Doctor Name: | DR. MARY KELLY SHANAHAN |
| NPI Number: | 1588661359 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MD |
| License Number: | 7055 |
| Business Practice Address: | 1154 Emerald Bay Rd South Lake Tahoe, CA - 961506288 |
| Business Phone Number: | 5305424961 |
| Business Fax Number: | 5305424964 |
| Mailing Address: | 1154 Emerald Bay Rd, SOUTH LAKE TAHOE |
| State: | CA |
| Postal Code: | 961506288 |
| Phone Number: | 5305424961 |
| Fax Number: | 5305424964 |
| NPI Enumeration Date: | 07/07/2005 |
| NPI Last Update Date: | 04/03/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207V00000X |
| License Number: | 7055 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | NV |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Obstetrics & Gynecology |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |