Provider Demographics
NPI:1598774846
Name:ALLEN, SHAWN ANNE (MD)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:ANNE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:79430 HIGHWAY 111
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-4547
Mailing Address - Country:US
Mailing Address - Phone:760-564-3533
Mailing Address - Fax:760-564-3360
Practice Address - Street 1:79430 HIGHWAY 111
Practice Address - Street 2:SUITE 101
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-4547
Practice Address - Country:US
Practice Address - Phone:760-564-3533
Practice Address - Fax:760-564-3360
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2017-07-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA71976207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAY048ZMedicare PIN