Provider Demographics
NPI:1740483387
Name:SNOW, SHANNA ROSE (DO)
Entity type:Individual
Prefix:DR
First Name:SHANNA
Middle Name:ROSE
Last Name:SNOW
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1860 PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3590
Mailing Address - Country:US
Mailing Address - Phone:707-646-4100
Mailing Address - Fax:707-646-4101
Practice Address - Street 1:1860 PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-3590
Practice Address - Country:US
Practice Address - Phone:707-646-4100
Practice Address - Fax:707-646-4101
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2016-04-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101016928207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIQ24657075Medicare PIN