Provider Demographics
NPI:1740205780
Name:SHANAHAN, CATHERINE E (MD)
Entity Type:Individual
Prefix:DR
First Name:CATHERINE
Middle Name:E
Last Name:SHANAHAN
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 1:8989 S ORANGE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-7904
Mailing Address - Country:US
Mailing Address - Phone:707-339-1976
Mailing Address - Fax:407-386-7383
Practice Address - Street 1:8989 S ORANGE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32824-7904
Practice Address - Country:US
Practice Address - Phone:707-339-1976
Practice Address - Fax:407-386-7383
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2020-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD-11164207Q00000X
CAC54747207Q00000X
CO0055110207Q00000X
CT55955207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
49577201OtherALOHACARE
G48893OtherKAISER
P00071255OtherRAILROAD MEDICARE
MD11164-01OtherLONGS/MDX
2494488OtherUHA
HI49577201Medicaid
00A0224863OtherHMSA
99-0262194OtherHMA
99-0262194OtherHMAA
99-0262194OtherHMAA
CAFQ308ZMedicare PIN
P00071255OtherRAILROAD MEDICARE