Provider Demographics
NPI:1356579379
Name:POTI, SHANNON MARGARET (MD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARGARET
Last Name:POTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARGARET
Other - Last Name:HIGGINS
Other - Suffix:IV
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2521 STOCKTON BLVD
Mailing Address - Street 2:STE. 7200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2207
Mailing Address - Country:US
Mailing Address - Phone:916-734-8157
Mailing Address - Fax:916-703-5011
Practice Address - Street 1:2521 STOCKTON BLVD
Practice Address - Street 2:STE. 7200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2207
Practice Address - Country:US
Practice Address - Phone:916-734-8157
Practice Address - Fax:916-703-5011
Is Sole Proprietor?:No
Enumeration Date:2009-06-29
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA174400000X-SPECIALIS174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist