Provider Demographics
NPI:1700895018
Name:TREANOR, SHANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:
Last Name:TREANOR
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 1:5101 COMMERCE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0411
Mailing Address - Country:US
Mailing Address - Phone:661-327-3756
Mailing Address - Fax:661-327-2332
Practice Address - Street 1:5101 COMMERCE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0411
Practice Address - Country:US
Practice Address - Phone:661-327-3756
Practice Address - Fax:661-327-2332
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70557207NP0225X, 208000000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H37199Medicare UPIN
CA00A705571Medicare ID - Type Unspecified