Provider Demographics
NPI:1740475920
Name:FALCON, SHANNON (MD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:FALCON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SHANNON
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12902 MAGNOLIA DR.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612
Mailing Address - Country:US
Mailing Address - Phone:888-860-2778
Mailing Address - Fax:
Practice Address - Street 1:12902 MAGNOLIA DR.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612
Practice Address - Country:US
Practice Address - Phone:888-860-2778
Practice Address - Fax:813-355-5099
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1067182085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006305100Medicaid
FL14L46OtherBLUE CROSS BLUE SHIELD
FLP01135662OtherR&R MEDICARE
FL006305100Medicaid
FLP01135662OtherR&R MEDICARE
FLGH449U - UCCMedicare PIN