Provider Demographics
NPI:1659830719
Name:MCALLISTER, SHANNON L (DO)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:MCALLISTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 S. GRAND BLVD.
Mailing Address - Street 2:
Mailing Address - City:ST. LOUISO
Mailing Address - State:MO
Mailing Address - Zip Code:63104
Mailing Address - Country:US
Mailing Address - Phone:314-268-4070
Mailing Address - Fax:314-268-4019
Practice Address - Street 1:1465 S. GRAND BLVD.
Practice Address - Street 2:
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63104
Practice Address - Country:US
Practice Address - Phone:314-268-4070
Practice Address - Fax:314-268-4019
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program