Provider Demographics
NPI:1285820175
Name:BARILLARE, SHANNON MARIE (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:BARILLARE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3685 STUTZ DR
Mailing Address - Street 2:STE 101
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9175
Mailing Address - Country:US
Mailing Address - Phone:330-729-9514
Mailing Address - Fax:330-729-9591
Practice Address - Street 1:3685 STUTZ DR
Practice Address - Street 2:STE 101
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9144
Practice Address - Country:US
Practice Address - Phone:330-729-9514
Practice Address - Fax:330-729-9591
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2016-10-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35.089101207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2217390Medicaid
OHH055260OtherMEDICARE PTAN