Provider Demographics
NPI:1891130027
Name:SURA, SHANNON B (DVM)
Entity Type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:B
Last Name:SURA
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 N HAYDEN RD
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85257-4417
Mailing Address - Country:US
Mailing Address - Phone:480-945-9466
Mailing Address - Fax:480-945-8250
Practice Address - Street 1:814 N HAYDEN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-4417
Practice Address - Country:US
Practice Address - Phone:480-945-9466
Practice Address - Fax:480-945-8250
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4497174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian