Shanahan, Mary Kelly
Shanahan, Mary Kelly is an sole proprietor health care provider with primary practice located at 1154 Emerald Bay Rd , South Lake Tahoe CA 96150-6288. She recently has only one registered license in Allopathic & Osteopathic Physicians / Obstetrics & Gynecology, which is considered as her primary health care specialty. Shanahan, Mary Kelly can be contacted via phone (530) 542-4961.Contact Information
Primary practice address
1154 Emerald Bay Rd
South Lake Tahoe CA 96150-6288
Phone: (530) 542-4961
Fax: (530) 542-4964
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | G78582 | California |
| Allopathic & Osteopathic Physicians / Obstetrics & Gynecology | 207V00000X | 7055 | Nevada |
Profile Details
| NPI number | 1588661359 |
|---|---|
| LBN Legal business name | Shanahan, Mary Kelly |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 7th, 2005 |
| Last updated | Apr 3rd, 2015 - about 11 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1588661359 | NPPES |
| California | MEDICAID | 1588661359 | |
| California | MEDICAID | 1588661359 |
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