Provider Demographics
NPI:1255541223
Name:GABRIEL-GRIGGS, SHANNON M (MD)
Entity type:Individual
Prefix:DR
First Name:SHANNON
Middle Name:M
Last Name:GABRIEL-GRIGGS
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 1:8170 33RD AVE S # MS 21110Q
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:640 JACKSON ST
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-2502
Practice Address - Country:US
Practice Address - Phone:651-254-4796
Practice Address - Fax:651-254-2741
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN55615207ZP0102X, 207ZP0102X
IA38817207ZH0000X, 207ZP0102X
SD8354207ZH0000X, 207ZP0102X
NE26803207ZP0102X
IAR-7808207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDS3026Medicare PIN
SDS34Medicare PIN