Provider Demographics
NPI:1720069115
Name:SHONNARD, PAUL YOUNG (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:YOUNG
Last Name:SHONNARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10635 PROFESSIONAL CIR STE A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5836
Mailing Address - Country:US
Mailing Address - Phone:775-852-0505
Mailing Address - Fax:775-852-0508
Practice Address - Street 1:10635 PROFESSIONAL CIR STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5836
Practice Address - Country:US
Practice Address - Phone:775-852-0505
Practice Address - Fax:775-852-0508
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV7756207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV20-16595Medicaid
CAXPY186986OtherMEDI-CAL PIN #
G25914Medicare UPIN
NV20WCGXF15Medicare ID - Type Unspecified
NV20-16595Medicaid