Provider Demographics
NPI:1790896587
Name:HARRIS, SHANNON E (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:E
Last Name:HARRIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:5700 BOTTINEAU BLVD
Mailing Address - Street 2:#210
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3183
Mailing Address - Country:US
Mailing Address - Phone:763-587-7000
Mailing Address - Fax:763-587-7015
Practice Address - Street 1:5700 BOTTINEAU BLVD
Practice Address - Street 2:#210
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55429-3183
Practice Address - Country:US
Practice Address - Phone:763-587-7000
Practice Address - Fax:763-587-7015
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2014-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN45728207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN979650900Medicaid
160002245Medicare ID - Type Unspecified
MN979650900Medicaid