Provider Demographics
NPI:1801215900
Name:PARIMI, SHANNON DELANEY (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:DELANEY
Last Name:PARIMI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:DELANEY
Other - Last Name:KOPSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:929 BARNARD COLLEGE LANE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63130
Mailing Address - Country:US
Mailing Address - Phone:636-236-4283
Mailing Address - Fax:618-222-9248
Practice Address - Street 1:SSM O'FALLON PEDIATRICS
Practice Address - Street 2:604 PIERCE BLVD
Practice Address - City:O'FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269
Practice Address - Country:US
Practice Address - Phone:618-222-9244
Practice Address - Fax:618-222-9248
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2019-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.143406208000000X
MO2017010788208000000X
390200000X
IL036143406208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training ProgramGroup - Single Specialty