Provider Demographics
NPI:1174028732
Name:SOTOUDEH, SHANNON JEAN (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:JEAN
Last Name:SOTOUDEH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-2717
Mailing Address - Country:US
Mailing Address - Phone:727-825-0111
Mailing Address - Fax:
Practice Address - Street 1:333 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-2717
Practice Address - Country:US
Practice Address - Phone:727-825-0111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME149545207K00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics