Provider Demographics
NPI:1215357025
Name:ALEJANDRO, SHANNON FAYE (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:FAYE
Last Name:ALEJANDRO
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 1:1631 LANCASTER DR STE 230
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-3586
Mailing Address - Country:US
Mailing Address - Phone:469-800-7200
Mailing Address - Fax:469-800-7210
Practice Address - Street 1:75B LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4353
Practice Address - Country:US
Practice Address - Phone:828-258-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-18
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2020-02441207X00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program