Provider Demographics
NPI:1336169804
Name:LORENZO-RIVERO, SHAUNA (MD)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:LORENZO-RIVERO
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:PO BOX 2379
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-2379
Mailing Address - Country:US
Mailing Address - Phone:606-408-6200
Mailing Address - Fax:
Practice Address - Street 1:613 23RD ST STE 430
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-2885
Practice Address - Country:US
Practice Address - Phone:606-408-8200
Practice Address - Fax:606-408-6291
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD43226208600000X
KY57522208C00000X, 208600000X
TN43226208C00000X
OH35.146884208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL101313Medicaid
5829223OtherCIGNA
GA259908999AMedicaid
TN1507110Medicaid
P00643432OtherRR MEDICARE
TN4187700OtherBCBS
TN3001391Medicare PIN