Provider Demographics
NPI:1457423782
Name:CABRERA, SHANNON RADEKE (MD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:RADEKE
Last Name:CABRERA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:MARIE
Other - Last Name:RADEKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 23RD STREET SOUTH
Mailing Address - Street 2:CENTRACARE CLINIC SAUK CROSSING
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4765
Mailing Address - Country:US
Mailing Address - Phone:320-229-5120
Mailing Address - Fax:320-200-3235
Practice Address - Street 1:2000 23RD STREET SOUTH
Practice Address - Street 2:CENTRACARE CLINIC SAUK CROSSING
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4765
Practice Address - Country:US
Practice Address - Phone:320-229-5120
Practice Address - Fax:320-200-3235
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN49115207W00000X
MN37730207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology