Provider Demographics
NPI:1487846267
Name:MACKENZIE, SHAWN (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:MACKENZIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 - 223 NELSON'S CRESENT
Mailing Address - Street 2:
Mailing Address - City:BURNABY
Mailing Address - State:BRITISH COLUMBIA
Mailing Address - Zip Code:V3L0E4
Mailing Address - Country:CA
Mailing Address - Phone:604-970-1096
Mailing Address - Fax:
Practice Address - Street 1:403 - 223 NELSON'S CRESENT
Practice Address - Street 2:
Practice Address - City:BURNABY
Practice Address - State:BRITISH COLUMBIA
Practice Address - Zip Code:V3L0E4
Practice Address - Country:CA
Practice Address - Phone:604-970-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-15
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60316843208600000X
ZZ41830208600000X
ORMD1602902086X0206X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology