Provider Demographics
NPI:1053936799
Name:ZULLO, SHANNON (MD)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:ZULLO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:SHANNON
Other - Middle Name:RENEE
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3151 WALBERT AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-6630
Mailing Address - Country:US
Mailing Address - Phone:484-503-7546
Mailing Address - Fax:
Practice Address - Street 1:3151 WALBERT AVE STE 301
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-6630
Practice Address - Country:US
Practice Address - Phone:484-503-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-09
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD491482207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology