Provider Demographics
NPI:1003310996
Name:SHRECKENGOST, CONSTANCE SCOTT HARRELL (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:SCOTT HARRELL
Last Name:SHRECKENGOST
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:DR
Other - First Name:CONSTANCE
Other - Middle Name:SCOTT
Other - Last Name:HARRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:2221 STOCKTON BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-1418
Mailing Address - Country:US
Mailing Address - Phone:916-734-2680
Mailing Address - Fax:
Practice Address - Street 1:2221 STOCKTON BLVD STE E
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-1418
Practice Address - Country:US
Practice Address - Phone:916-734-2680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-23
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA201258208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery