SHANNON RAE SGRO (NPI# 1396790358) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1396790358 |
| Entity Type | Individual |
| Full Name | SHANNON RAE SGRO |
| Credential | P.A.-C |
| Practice Address |
1412 Blue Oaks Blvd Roseville CA 95747-7143 |
| Practice Telephone | 9167847546 |
| Practice Fax Number | 9167847548 |
| Mailing Telephone | 9167847546 |
| Mailing Fax Number | 9167847548 |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2016-08-01 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA15649 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
1412 BLUE OAKS BLVD |
| City | ROSEVILLE |
| State | CA |
| Zip Code | 95747-7143 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194764738 | Christopher H Ha | Dermatology | 1412 Blue Oaks Blvd, Roseville, CA 95747-7143 | 2006-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215407051 | Clifford Leo Faubert | Nurse Practitioner | 1937 Ellesmere Loop, Roseville, CA 95747 | 2018-12-04 |
| 1821577172 | Adam Botwinik | Psychologist | 8849 Cook Riolo Road, Roseville, CA 95747 | 2018-08-08 |
| 1093231201 | Heather Mairi Ybarra | Behavior Technician | 4216 Wyman Way, Roseville, CA 95747 | 2017-08-18 |
| 1881114650 | Bridget Bell | Behavior Technician | 8202 Tail Race Dr, Roseville, CA 95747 | 2017-06-22 |
| 1760911192 | Laura Marie Hummel | Massage Therapist | 9077 Foothills Blvd. Suite 200, Roseville, CA 95747 | 2017-06-08 |
| 1184975625 | Whitney Anne Wright | Marriage & Family Therapist | 7517 Locomotive Ln, Roseville, CA 95747 | 2012-09-24 |
| 1962764290 | Panumas Soukaroon | Physical Medicine & Rehabilitation | Glenwood Springs Way, Roseville, CA 95747 | 2012-06-12 |
| 1134487366 | Tatyana Serikov | Dental Hygienist | 616 Treviso Ct, Roseville, CA 95747 | 2012-04-25 |
| 1720352099 | Peggy Holcomb | Clinical Neuropsychologist | 4010 Foothills Bvld., Ste. 103-3, Roseville, CA 95747 | 2012-03-02 |
| 1740577220 | Laina Marie Haider | Occupational Therapist | 7950 Footthills Blvd, The Bridges At Woodcreek Oaks, Roseville, CA 95747 | 2011-07-05 |
| Find all providers in zip 95747 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497152763 | Joshua Lewis Cavaness | Physician Assistant | 2 Medical Plaza Dr Ste 255, Roseville, CA 95661-3050 | 2014-12-02 |
| 1619277712 | Anjali K Wilkerson | Physician Assistant | 576 N. Sunrise Ave, Ste. 220, Roseville, CA 95661 | 2010-10-24 |
| 1043305733 | Dorothy Ann Zamborsky | Physician Assistant | 851 Pleasant Grove Blvd Ste 110, Roseville, CA 95678-6176 | 2006-10-04 |
| 1285665620 | Julie Marie Gebhardt | Physician Assistant | 3001 Douglas Blvd Ste 325, Roseville, CA 95661-4289 | 2006-07-05 |
| 1417595760 | William Murray | Physician Assistant | 1 Medical Plaza Dr, Roseville, CA 95661-3037 | 2019-12-17 |
| 1366899437 | Chloe Ferrar | Physician Assistant | 1835 County Road C W, Roseville, MN 55113-1352 | 2016-05-18 |
| 1811354244 | Natalie Hope Pautsch | Physician Assistant | 2831 Snelling Ave N, Roseville, MN 55113-1712 | 2016-01-14 |
| 1609269927 | Abby Stretch | Physician Assistant | 4010 Foothills Blvd Ste 102, Roseville, CA 95747-7241 | 2015-03-11 |
| 1629460670 | Matthew Luther Case | Physician Assistant | 1 Medical Plaza Dr, Roseville, CA 95661-3037 | 2015-02-27 |
| 1518364405 | Anita Athavale | Physician Assistant | 701 Sunrise Ave, Roseville, CA 95661-4502 | 2014-11-20 |
| Find all providers in ROSEVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.