Individual
MS. MARYELLEN KATHRYN SHANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
6 HUGHES, STE 100, IRVINE, CA 92618-2059
(949) 680-1880
(949) 680-1881
Mailing address
6 HUGHES, STE 100, IRVINE, CA 92618-2059
(949) 680-1880
(949) 680-1881
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
AZ19717
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04886
—
AZ
Enumeration date
08/27/2006
Last updated
01/02/2015
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