Doctor Name: | DR. JEFFREY STEVENS SHANNON |
NPI Number: | 1649375148 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A36291 |
Business Practice Address: | 2027 Village Ln Suite 102 Solvang, CA - 934632283 |
Business Phone Number: | 8056883440 |
Business Fax Number: | 8056865694 |
Mailing Address: | 2027 Village Ln, Suite 102 SOLVANG |
State: | CA |
Postal Code: | 934632283 |
Phone Number: | 8056883440 |
Fax Number: | 8056865694 |
NPI Enumeration Date: | 09/13/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A36291 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |