Provider Demographics
NPI:1760648026
Name:REED, SHANNON CARYN (DO)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:CARYN
Last Name:REED
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:CARYN
Other - Last Name:LAMPERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:MINERAL POINT
Mailing Address - State:WI
Mailing Address - Zip Code:53565-1289
Mailing Address - Country:US
Mailing Address - Phone:608-987-2346
Mailing Address - Fax:608-987-2490
Practice Address - Street 1:1100 DELAPLAINE CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-1840
Practice Address - Country:US
Practice Address - Phone:608-241-9020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI55165207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine