Provider Demographics
NPI:1295298834
Name:SOBRIO, SHANE ALEXANDER (MD)
Entity type:Individual
Prefix:
First Name:SHANE
Middle Name:ALEXANDER
Last Name:SOBRIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1155 MILL ST # MCM14
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502-1576
Mailing Address - Country:US
Mailing Address - Phone:775-982-5000
Mailing Address - Fax:775-982-5225
Practice Address - Street 1:975 RYLAND ST STE 100
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-1669
Practice Address - Country:US
Practice Address - Phone:775-982-5000
Practice Address - Fax:775-982-5225
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2025-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NV23872207P00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine