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Individual

SHANNON RENAE SUTHERLAND

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
D.O.

Contact information

Practice address
1103 VILLAGE SQUARE DR, SUITE 101, PERRYSBURG, OH 43551-1783
(419) 872-3219
(419) 872-3208
Mailing address
5901 MONCLOVA RD, MAUMEE, OH 43537
(419) 872-3201
(419) 872-3208

Taxonomy

Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
34.008522
OH
207V00000X
Obstetrics & Gynecology Physician
BL9255058
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2604793
OH
Enumeration date
12/22/2005
Last updated
01/18/2011
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