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Individual
SHANNON M BERRY
Active
Individual
SHANNON M BERRY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A070193
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A701930
—
CA
01
—
A070193
BLUE SHIELD
CA
Enumeration date
08/17/2005
Last updated
03/07/2023
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