Provider Demographics
NPI:1023005303
Name:ZAMBONI, SHANNON L (MD)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:L
Last Name:ZAMBONI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:601 RALSTON ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89503-4436
Mailing Address - Country:US
Mailing Address - Phone:775-786-1110
Mailing Address - Fax:775-788-8075
Practice Address - Street 1:601 RALSTON ST
Practice Address - Street 2:SUITE 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89503-4436
Practice Address - Country:US
Practice Address - Phone:775-786-1110
Practice Address - Fax:775-788-8075
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV9022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV33585Medicare ID - Type Unspecified
H05771Medicare UPIN