Provider Demographics
NPI:1275158131
Name:SALERNO, SHANNON (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SALERNO
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 1:4650 SIGNAL TREE DR STE 1200
Mailing Address - Street 2:
Mailing Address - City:TIMNATH
Mailing Address - State:CO
Mailing Address - Zip Code:80547-4908
Mailing Address - Country:US
Mailing Address - Phone:970-237-7415
Mailing Address - Fax:970-237-7420
Practice Address - Street 1:4650 SIGNAL TREE DR STE 1200
Practice Address - Street 2:
Practice Address - City:TIMNATH
Practice Address - State:CO
Practice Address - Zip Code:80547-4908
Practice Address - Country:US
Practice Address - Phone:970-237-7415
Practice Address - Fax:970-237-7420
Is Sole Proprietor?:No
Enumeration Date:2020-06-16
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0071502207Q00000X
IAR-11955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine