| Shannon Easton-carr, Md, Inc | |
|
2102 Edsel Ave Modesto CA 95350-2819 | |
| (805) 762-4739 | |
| (888) 462-8045 |
| Full Name | Shannon Easton-carr, Md, Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 2102 Edsel Ave, Modesto, California |
| Authorized Official Name and Position | Shannon Easton-carr (PRESIDENT) |
| Authorized Official Contact | 8057624739 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Shannon Easton-carr, Md, Inc 1241 Johnson Ave Box 313 San Luis Obispo CA 93401-3306 Ph: (805) 762-4739 | Shannon Easton-carr, Md, Inc 2102 Edsel Ave Modesto CA 95350-2819 Ph: (805) 762-4739 |
| NPI Number | 1821480864 |
|---|---|
| Provider Enumeration Date | 02/27/2015 |
| Last Update Date | 06/05/2024 |
| Certification Date | 06/05/2024 |
| Medicare PECOS PAC ID | 0143513671 |
|---|---|
| Medicare Enrollment ID | O20160721001290 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821480864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | A111411 (California) | Primary |
| Provider Name | Shannon M Easton-carr |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508091711 PECOS PAC ID: 9234316464 Enrollment ID: I20110615000485 |
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