Provider Demographics
NPI:1700155363
Name:GUZMAN, SHANNON MARIE (DMSC, PA-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:GUZMAN
Suffix:
Gender:F
Credentials:DMSC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 ESTERS BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2233
Mailing Address - Country:US
Mailing Address - Phone:415-424-2666
Mailing Address - Fax:415-520-6633
Practice Address - Street 1:10775 PIONEER TRL STE 215
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-0234
Practice Address - Country:US
Practice Address - Phone:415-424-4266
Practice Address - Fax:209-370-9034
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2024-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003286773AMedicaid
WA2200821Medicaid
NV250016698Medicaid
VA30017641300001Medicaid
MO830115312Medicaid
FL117506800Medicaid
TX1700155363Medicaid
CA100240434Medicaid
CO9000199549Medicaid