Provider Demographics
NPI:1871567164
Name:DENNO, SHELLEEN E (MD)
Entity type:Individual
Prefix:
First Name:SHELLEEN
Middle Name:E
Last Name:DENNO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2285 OLIVET LANE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401
Mailing Address - Country:US
Mailing Address - Phone:707-526-0465
Mailing Address - Fax:707-526-0465
Practice Address - Street 1:2285 OLIVET LANE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401
Practice Address - Country:US
Practice Address - Phone:707-526-0465
Practice Address - Fax:707-526-0465
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA50098207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF51491Medicare UPIN