Provider Demographics
NPI:1710968227
Name:MCCANN, SHANNAN ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:SHANNAN
Middle Name:ELIZABETH
Last Name:MCCANN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 OAKWELL CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-3128
Mailing Address - Country:US
Mailing Address - Phone:210-829-5180
Mailing Address - Fax:210-829-5030
Practice Address - Street 1:21727 IH-10 WEST
Practice Address - Street 2:2ND FLOOR, SUITE 202
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257
Practice Address - Country:US
Practice Address - Phone:210-829-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7063207NP0225X, 207N00000X
MS20464208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice