Provider Demographics
NPI:1528591187
Name:LANZO, SHANNON MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:MICHELLE
Last Name:LANZO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 412826, BOSTON
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-0001
Mailing Address - Country:US
Mailing Address - Phone:610-892-8889
Mailing Address - Fax:484-446-8005
Practice Address - Street 1:100 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6136
Practice Address - Country:US
Practice Address - Phone:973-971-5370
Practice Address - Fax:973-290-7294
Is Sole Proprietor?:No
Enumeration Date:2017-04-10
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ25MA118080002085R0202X
CAA1760162085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology